中国实用外科杂志

中国实用外科杂志

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三维可视引导下经3D腹腔镜胆道硬镜靶向碎石治疗肝胆管结石36例临床分析

方驰华，蔡    伟，莫志康，黄文杰，范应方，杨    剑，项    楠，曾    宁   

  1. 南方医科大学珠江医院肝胆一科，广东广州510282
  • 出版日期:2016-03-01 发布日期:2016-03-01

  • Online:2016-03-01 Published:2016-03-01

摘要：

目的    研究三维可视引导下经3D腹腔镜胆道硬镜靶向碎石在肝胆管结石诊治中的临床应用价值。方法    选择2014年5月至2015年5月间36例肝胆管结石病人临床资料，其中男性16例，女性20例，年龄30～73岁，平均53.8岁。采用腹部医学图像三维可视化软件（MI-3DVS）对肝胆管结石进行三维可视化临床分型和术前规划，指导3D腹腔镜联合胆道硬镜靶向碎石、网石、取石。结果    三维可视化临床分型：Ⅰ型18例，Ⅰ+Ea型2例，Ⅱa型5例，Ⅱa+Ea型2例，Ⅱb型7例，Ⅱb+Ea型1例，Ⅱc型1例。术中所见均与三维可视化图像模型吻合，实际手术方式与术前规划均一致。经硬镜检查，术中取尽结石。手术时间（128.6±20.3）（100～165）min，术中出血（27.1±16.6）（10～80）mL，无围手术期死亡，无输血，无大出血。胆道损伤1例，经保守治疗后痊愈。术后随访（12.9±3.6）（7～19）个月，无结石残留和复发病例。结论    三维可视引导下经3D腹腔镜胆道硬镜靶向碎石术，是肝胆管结石数字化微创外科治疗的一种安全有效的方式。

关键词: 肝胆管结石, 三维可视化, 3D腹腔镜, 微创外科

Abstract:

Three-dimensional laparoscope combined with rigid choledochoscope targeting lithotripsy in the treatment of hepatolithiasis guided by three-dimensional visualization technology：A clinical analysis of 36 cases        FANG Chi-hua，CAI Wei，MO Zhi-kang，et al. The First Department of Hapatobiliary Surgery，Zhujiang Hospital，Southern Medical University，Guangzhou510282，China
Corresponding author：FANG Chi-hua，E-mail：fangch_dr@126.com
Abstract    Objective    To study the clinical application value of three-dimensional (3D) laparoscope combined with rigid choledochoscope targeting lithotripsy in the treatment of hepatolithiasis guided by 3D visualization technology. Methods    A total of 36 patients with hepatolithiasis from May 2014 to May 2015 were analyzed. There were 16 males and 20 females with an average age of 53.8 years (range 30～73 years old). The medical image 3D visualization system (MI-3DVS) was used to perform the clinical typing of diagnosis and surgical planning and direct the 3D laparoscope combined with rigid choledochoscope targeting lithotripsy by basket lithotripter and forceps to take out hepatic calculus. Results    Outcomes of 3D clinical typing：18 cases of typeⅠ，2 cases of type Ⅰ+Ea，5 cases of type Ⅱa，2 cases of type Ⅱa+Ea，7 cases of type Ⅱb，1 case of type Ⅱb+Ea，1 case of type Ⅱc. The 3D image models were in tune with operation findings. The surgical planning is consistent with actual operation. The stones were completely removed during operation with the examination of rigid choledochoscope. The time of operation was （128.6±20.3）（100—165）mins and intraoperative blood loss was （27.1±16.6）（10—80）mL. No death happened during perioperative and without blood transfusion and massive haemorrhage. One case of bile duct injury was occurred and recovered after conservative treatments. All the cases were followed up for（12.9±3.6）（7—19）months after operation，and no one had residual calculi and recurrence. Conclusion The 3D laparoscope combined with rigid choledochoscope targeting lithotripsy in the treatment of hepatolithiasis is a safe and effective therapic modality，which forms part of the digital minsimally invasive surgery in the treatment of hepatolithiasis.

Key words: hepatolithiasis, three-dimensional visualization, three-dimensional laparoscope, minimally invasive surgery