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  

Application of digital medical technologies in percutaneous transhepatic cholangioscopy lithotripsy for the treatment of hepatolithiasis

作　　者：王平[1] 陈小伍[1] 方驰华[2] 罗康宁[1] 范应方[2] 

机构地区：[1]南方医科大学附属顺德市第一人民医院普通外科,528300 [2]南方医科大学珠江医院肝胆一科,广州510282

出　　处：《中华消化外科杂志》2013年第5期352-357,共6页Chinese Journal of Digestive Surgery

基　　金：国家高技术研究发展计划（863计划）项目（2006AA022346）

摘　　要：目的 探讨医学图像三维可视化系统（MI-3DVS）在经皮肝胆道镜碎石（PTCSL）治疗肝胆管结石病中的临床应用价值。方法 回顾性分析2007年1月至2012年9月两家临床研究中心收治的66例肝胆管结石病患者（南方医科大学附属顺德第一人民医院55例。南方医科大学珠江医院11例）的临床资料。运用MI-3DVS对CT图像进行三维重建, 明确结石分布范围。数量。大小。形状等特点,以及与周围肝组织。血管。胆管的关系;术前确定疾病分型,制订PTCSL手术预案,指导施行PTCSL手术,根据术中及术后恢复情况综合评价三维重建可视化技术的应用价值。患者术后采用电话。门诊复查等方式进行随访。结果 采用MI-3DVS成功完成66例患者肝脏。胆道系统。结石。血管三维重建;清晰显示结石的大小。数量。形态。空间位置,胆管狭窄的位置。程度。长度以及周围血管的空间解剖关系。PTCSL手术预案与实际手术的符合率为95.5%（63/66）。63例患者手术时间为（117±9）min,术中出血量为（18±1）ml,术后结石清除率为92.4%（61/66）,术后并发症发生率为6.1%（4/66）,术后住院时间为（15±4）d。本组患者随访时间截至2012年9月,中位随访时间为16个月（1~69个月）,随访率为100.0%（66/66）,术后结石复发率为9.1%（6/66）,术后因肿瘤转移并发MODS死亡1例。结论 应用MI-3DVS对肝胆管结石病患者进行诊断和指导PTCSL手术,可有效提高PTCSL手术的安全性和有效性。Objective To investigate the clinical value of medical imagethree dimensional visible system （MI-3DVS） in percutaneous transhepatic cholangioscopy lithotripsy （PTCSL） for the treatment of hepatolithiasis.Methods The clinical data of 66 patients with hepatolithiasis （55 were from the First People′s Hospital of Shunde City and 11 were from the Zhujiang Hospital） were retrospectively analyzed. The images of computed tomography were threedimensionally reconstructed with MI-3DVS. The location, number, size, shape of the stones were figured out, and the operation strategies of PTCSL were designed according to the types of the disease. The clinical value of MI-3DVS was evaluated according to the operation results and postoperative recovery of patients. All the patients were followed up via telephone or outpatient reexamination.Results Liver, biliary system, stones and blood vessels were threedimensionally reconstructed with the MI-3DVS, and the size, number, shape, location of the stones and location, degree, length of the biliary stricture and its anatomical relationship with adjacent blood vessels were clearly displayed. The coincidence rate of planned and actual operations was 95.5%（63/66）. The mean operation time, intraoperative blood loss, rate of stone clearance, complication rate and duration of hospital stay of 63 patients were （117±9）minutes,（18±1）ml,92.4%（61/66）,6.1%（4/66） and （15±4）days, respectively. All the patients were followed up till September 2012,the median survival time was 16 months （range, 1-69 months）,and the recurrence rate of hepatolithiasis was 9.1%（6/66）. One patient died of tumor metastasis and multiorgan dysfunction syndrome postoperatively.Conclusion MI-3DVS could effectively improve the safety and efficiency of PTCSL for patients with hepatolithiasis.

关 键 词：肝胆管结石病 数字医学 胆道镜探查 

分 类 号：R657.4[医药卫生—外科学]