三维可视化技术指导肝段切除联合胆道硬镜在复杂肝胆管结石治疗中的应用
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摘要
目的:探讨应用三维可视化技术指导肝段切除联合胆道硬镜治疗复杂肝胆管结石病的临床效果。方法:选取采取三维可视化技术联合胆道硬镜治疗的复杂肝胆管结石病患者47例作为研究组,常规手术治疗的58例患者作为对照组,比较两组患者的手术效果、并发症及远期复发情况。结果:研究组患者的手术时间、手术出血量、输血量、肝脏血流阻断时间均低于对照组患者且差异均有统计学意义(均P<0.05);研究组患者的结石清除率明显高于对照组患者的(95.74%vs.81.03%,P<0.05);研究组术后的ALB水平明显高于对照组、白细胞水平明显低于对照组(均P<0.05);研究组和对照组患者术后发生胆汁漏、胆管炎复发、肝段萎缩、腹痛的发生率差异均无统计学意义(均P>0.05),但研究组术后黄疸、发热发生率明显低于对照组的(均P<0.05)。结论:三维可视化技术有利于手术操作的精确性,减轻对患者的创伤、增加胆管结石的清除率,减少手术并发症。
引文
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[7]曾凡华.肝脏三维可视化模型在肝脏超声影像学肝段划分中的价值分析[J].中国社区医师,2016,32(35):142.doi:10.3969/j.issn.1007-614x.2016Zeng FH.Value analysis of three-dimensional visualization model of liver in the hepatic segment division of liver ultrasonography[J].Chinese Community Doctors,2016,32(35):142.doi:10.3969/j.issn.1007-614x.2016.35.82.
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[9]周卫忠,伍迎文,覃华强,等.LC辅助小切口胆总管探查取石治疗复杂肝胆管结石的临床应用[J].中国现代普通外科进展,2014,17(4):316-317.doi:10.3969/j.issn.1009-9905.2014.04.020.Zhou WZ,Wu YW,Qin HQ,et al.Clinical application of common bile duct exploration and stone extraction via LC-assisted small incision in treatment of hepatolithiasis[J].Chinese Journal of Current Advances in General Surgery,2014,17(4):316-317.doi:10.3969/j.issn.1009-9905.2014.04.020.
[10]高合增.腹腔镜与开腹手术治疗胆管结石的临床效果比较[J].中国现代普通外科进展,2013,16(3):223-224.doi:10.3969/j.issn.1009-9905.2013.03.018.Gao HZ.Efficacy comparison between laparoscopic and open surgery in treatment of biliary stones[J].Chinese Journal of Current Advances in General Surgery,2013,16(3):223-224.doi:10.3969/j.issn.1009-9905.2013.03.018.
[11]成伟,陈道瑾,彭创,等.解剖法与非解剖法肝切除在肝胆管结石治疗中的应用与近期效果分析[J].中国普通外科杂志,2012,21(8):913-917.Cheng W,Chen DJ,Peng C,et al.Application and effects analysis of anatomical and nonanatomical hepatectomy for hepatolithiasis[J].Chinese Journal of General Surgery,2012,21(8):913-917.
[12]王永忠.多处肝切除治疗复杂肝胆管结石病手术7 1例分析[J].中国医药导刊,2012,14(8):1308-1309.doi:10.3969/j.issn.1009-0959.2012.08.011.Wang YZ.Multiple Hepatic Resection in the Treatment of Complex Hepatolithiasis Operation Analysis of 71 Cases[J].Chinese Journal of Medical Guide,2012,14(8):1308-1309.doi:10.3969/j.issn.1009-0959.2012.08.011.
[13]陈亚进.肝胆管结石病多次手术原因及决策[J].中国实用外科杂志,2012,32(1):57-59.Chen YJ.The cause of Hepatolithiasis reoperation and treatment decisions[J].Chinese Journal of Practical Surgery,2012,32(1):57-59.
[14]方驰华,刘文瑛,范应方,等.三维可视化技术指导经硬镜靶向碎石治疗肝胆管结石[J].中华外科杂志,2014,52(2):117-121.doi:10.3760/cma.j.issn.0529-5815.2014.02.009.Fang CH,Liu WY,Fan YF,et al.Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology[J].Chinese Journal of Surgery,2014,52(2):117-121.doi:10.3760/cma.j.issn.0529-5815.2014.02.009.
[15]Fang CH,Liu J,Fan YF,et a1.Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique[J].J Am Coll Surg,2013,217(2):280-288.doi:10.1016/j.jamcollsurg.2013.03.017.
[16]项楠,方驰华.三维可视化指导肝段切除联合胆道硬镜治疗复杂肝胆管结石[J].中华外科杂志,2015,53(5):335-339.doi:10.3760/cma.j.issn.0529-5815.2015.05.004.Xiang N,Fang CH.Application of hepatic segment resection combined with rigid choledochoscope in the treatment of complex hepatolithiasis guided by three-dimensional visualization technology[J].Chinese Journal of Surgery2015,53(5):335-339.doi:10.3760/cma.j.issn.0529-5815.2015.05.004.
[17]Jarufe N,Figueroa E,Mufioz C,et a1.Anatomic hepatectomy as a definitive treatment for hepatolithiasis:a cohort study[J].HPB(Oxford),2012,14(9):604-610.doi:10.1111/j.1477-2574.2012.00488.x.
[18]Jiang H,Wu H,Xu YL,et a1.An appraisal of anatomical and limited hepatectomy for regional hepatolithiasis[J].HPB Surg,2010,2010:791625.doi:10.1155/2010/791625.
[19]王平,陈小伍,方驰华,等.数字医学技术在经皮肝胆道镜碎石治疗肝胆管结石病中的应用[J].中华消化外科杂志,2013,12(5):352-357.doi:10.3760/cma.j.issn.1673-9752.2013.05.008.Wang P,Chen XW,Fang CH,et al.Application of digital medical technologies in percutaneous transhepatic cholangioscopy lithotripsy for the treatment of hepatolithiasis[J].Chinese Journal of Digestive Surgery,2013,12(5):352-357.doi:10.3760/cma.j.issn.1673-9752.2013.05.008.
[20]Yang T,Lau WY,Lai EC,et a1.Hepatectomy for bilateral primary hepatolithiasis:a cohort study[J].Ann Surg,2010,25l(1):84-90.
[2]张黎,胡明道,魏晓平,等.精准肝切除术治疗复杂性肝胆管结石:附60例报告[J].中国普通外科杂志,2013,22(2):131-134.doi:10.7659/j.issn.1005-6947.2013.02.001.Zhang L,Hu MD,Wei XP,et al.Precise hepatectomy for complicated hepatolithiasis:a report of 60 cases[J].Chinese Journal of General Surgery,2013,22(2):131-134.doi:10.7659/j.issn.1005-6947.2013.02.001.
[3]Fang CH,Xie AW,Chen ML,et a1.Application of a visible simulation surgery technique in preoperation planning for intrahepatic calculi[J].World J Surg,2010,34(2):327-335.doi:10.1007/s00268-009-0310-1.
[4]沈刘娉,孙迎,孙毅勇,等.医疗定位系统的精度测试方法研究[J].现代仪器与医疗,2015,21(5):11-13.doi:10.11876/mimt201505004.Shen LP,Sun Y,Sun YY,et al.Methods for testing the accuracy of medical positioning systems[J].Modern Instruments&Mediccal Treatment,2015,21(5):11-13.doi:10.11876/mimt201505004.
[5]方驰华,陈建新.数字医学技术在肝胆管结石病诊断和治疗中的应用[J].中华消化外科杂志,2012,11(2):104-107.doi:10.3760/cma.j.issn.1673-9752.2012.02.004.Fang CH,Chen JX.Application of digital medical technology in the diagnosis and treatment of hepatolithiasis[J].Chinese Journal of Digestive Surgery,2012,11(2):104-107.doi:10.3760/cma.j.issn.1673-9752.2012.02.004.
[6]中华医学会外科学分会胆道外科学组.肝胆管结石病诊断治疗指南[J].中华消化外科杂志,2007,6(2):156-161.doi:10.3760/cma.j.issn.1673-9752.2007.02.028.Biliary Surgery Group of Surgery Branch of Chinese Medical Association.Guidelines for diagnosis and treatment of hepatolithiasis[J].Chinese Journal of Digestive Surgery,2007,6(2):156-161.doi:10.3760/cma.j.issn.1673-9752.2007.02.028.
[7]曾凡华.肝脏三维可视化模型在肝脏超声影像学肝段划分中的价值分析[J].中国社区医师,2016,32(35):142.doi:10.3969/j.issn.1007-614x.2016Zeng FH.Value analysis of three-dimensional visualization model of liver in the hepatic segment division of liver ultrasonography[J].Chinese Community Doctors,2016,32(35):142.doi:10.3969/j.issn.1007-614x.2016.35.82.
[8]方驰华,张永祥,范应方,等.个体化肝静脉、门静脉三维重建在肝切除术中的应用[J].中华外科杂志,2014,52(1):45-49.doi:10.3760/cma.j.issn.0529-5815.2014.01.011.Fang CH,Zhang YX,Fan YF,et al.Three-dimensional reconstruction of individual hepatic veins and portal veins system in hepatectomy[J].Chinese Journal of Surgery,2014,52(1):45-49.doi:10.3760/cma.j.issn.0529-5815.2014.01.011.
[9]周卫忠,伍迎文,覃华强,等.LC辅助小切口胆总管探查取石治疗复杂肝胆管结石的临床应用[J].中国现代普通外科进展,2014,17(4):316-317.doi:10.3969/j.issn.1009-9905.2014.04.020.Zhou WZ,Wu YW,Qin HQ,et al.Clinical application of common bile duct exploration and stone extraction via LC-assisted small incision in treatment of hepatolithiasis[J].Chinese Journal of Current Advances in General Surgery,2014,17(4):316-317.doi:10.3969/j.issn.1009-9905.2014.04.020.
[10]高合增.腹腔镜与开腹手术治疗胆管结石的临床效果比较[J].中国现代普通外科进展,2013,16(3):223-224.doi:10.3969/j.issn.1009-9905.2013.03.018.Gao HZ.Efficacy comparison between laparoscopic and open surgery in treatment of biliary stones[J].Chinese Journal of Current Advances in General Surgery,2013,16(3):223-224.doi:10.3969/j.issn.1009-9905.2013.03.018.
[11]成伟,陈道瑾,彭创,等.解剖法与非解剖法肝切除在肝胆管结石治疗中的应用与近期效果分析[J].中国普通外科杂志,2012,21(8):913-917.Cheng W,Chen DJ,Peng C,et al.Application and effects analysis of anatomical and nonanatomical hepatectomy for hepatolithiasis[J].Chinese Journal of General Surgery,2012,21(8):913-917.
[12]王永忠.多处肝切除治疗复杂肝胆管结石病手术7 1例分析[J].中国医药导刊,2012,14(8):1308-1309.doi:10.3969/j.issn.1009-0959.2012.08.011.Wang YZ.Multiple Hepatic Resection in the Treatment of Complex Hepatolithiasis Operation Analysis of 71 Cases[J].Chinese Journal of Medical Guide,2012,14(8):1308-1309.doi:10.3969/j.issn.1009-0959.2012.08.011.
[13]陈亚进.肝胆管结石病多次手术原因及决策[J].中国实用外科杂志,2012,32(1):57-59.Chen YJ.The cause of Hepatolithiasis reoperation and treatment decisions[J].Chinese Journal of Practical Surgery,2012,32(1):57-59.
[14]方驰华,刘文瑛,范应方,等.三维可视化技术指导经硬镜靶向碎石治疗肝胆管结石[J].中华外科杂志,2014,52(2):117-121.doi:10.3760/cma.j.issn.0529-5815.2014.02.009.Fang CH,Liu WY,Fan YF,et al.Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology[J].Chinese Journal of Surgery,2014,52(2):117-121.doi:10.3760/cma.j.issn.0529-5815.2014.02.009.
[15]Fang CH,Liu J,Fan YF,et a1.Outcomes of hepatectomy for hepatolithiasis based on 3-dimensional reconstruction technique[J].J Am Coll Surg,2013,217(2):280-288.doi:10.1016/j.jamcollsurg.2013.03.017.
[16]项楠,方驰华.三维可视化指导肝段切除联合胆道硬镜治疗复杂肝胆管结石[J].中华外科杂志,2015,53(5):335-339.doi:10.3760/cma.j.issn.0529-5815.2015.05.004.Xiang N,Fang CH.Application of hepatic segment resection combined with rigid choledochoscope in the treatment of complex hepatolithiasis guided by three-dimensional visualization technology[J].Chinese Journal of Surgery2015,53(5):335-339.doi:10.3760/cma.j.issn.0529-5815.2015.05.004.
[17]Jarufe N,Figueroa E,Mufioz C,et a1.Anatomic hepatectomy as a definitive treatment for hepatolithiasis:a cohort study[J].HPB(Oxford),2012,14(9):604-610.doi:10.1111/j.1477-2574.2012.00488.x.
[18]Jiang H,Wu H,Xu YL,et a1.An appraisal of anatomical and limited hepatectomy for regional hepatolithiasis[J].HPB Surg,2010,2010:791625.doi:10.1155/2010/791625.
[19]王平,陈小伍,方驰华,等.数字医学技术在经皮肝胆道镜碎石治疗肝胆管结石病中的应用[J].中华消化外科杂志,2013,12(5):352-357.doi:10.3760/cma.j.issn.1673-9752.2013.05.008.Wang P,Chen XW,Fang CH,et al.Application of digital medical technologies in percutaneous transhepatic cholangioscopy lithotripsy for the treatment of hepatolithiasis[J].Chinese Journal of Digestive Surgery,2013,12(5):352-357.doi:10.3760/cma.j.issn.1673-9752.2013.05.008.
[20]Yang T,Lau WY,Lai EC,et a1.Hepatectomy for bilateral primary hepatolithiasis:a cohort study[J].Ann Surg,2010,25l(1):84-90.