三维可视化技术指导经硬镜靶向碎石治疗肝胆管结石  

Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasisguided by three-dimensional visualization technology

作　　者：方驰华[1] 刘文瑛[1] 范应方[1] 杨剑[1] 项楠[1] 曾宁[1] 

机构地区：[1]南方医科大学珠江医院肝胆外科,广州510282

出　　处：《中华外科杂志》2014年第2期117-121,共5页Chinese Journal of Surgery

基　　金：国家高技术研究发展计划（863计划）资助项目（2006AA022346、2012AA021105）;国家自然科学基金资助项目（81170458）;广东省自然科学基金团队资助项目（6200171）;广东省重大科技专项计划资助项目（2012A080203013）;广东省中科院全面战略协作项目（20100904）;广东省科技计划项目（2011t1031800088、20118031800091）

摘　　要：目的研究三维可视化技术指导经胆道硬镜靶向气压弹道碎石在肝胆管结石诊治中的临床应用价值。方法选择2012年2月至2013年6月问26例肝胆管结石患者，其中男性11例，女性15例，年龄31～75岁（平均55．2岁），病程3～16年（平均8．5年）。运用腹部医学图像三维可观化软件对肝胆管结石进行三维重建和3D分型，指导经胆道硬镜靶向气压弹道碎石治疗肝胆管结石。结果本组26例患者实际手术所见均与三维重建模型吻合。三维可视化技术指导行经皮肝窦道胆道硬镜靶向碎石取石术19例，包括ⅡC型结石4例；腹腔镜联合胆道硬镜靶向碎石取石术3例；开腹手术胆道硬镜靶向碎石取石术4例。3例患者经二次硬镜取石，最终结石清除率100％。1例合并胆管癌变转开腹根治术。手术时间（100．8±7．6）rain；术中出血（41．7±8．5）ml；术后住院时间（7．0±0．6）d。1例患者术后胆道出血；无胆道损伤、大出血、胆漏等并发症发生。结论三维可视化技术指导经胆道硬镜靶向气压弹道碎石取石术，实现肝胆管结石的数字化微创治疗。Objective To study the value of rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis under the guidance of three-dimensional visualization technology. Methods The 26 patients with hepatolithiasis from February 2012 to June 2013 were analyzed. There were 11 male and 15 female patients with a median age of 55.2 years （range 31-75 years old）. The image data of CT scanning of hepatolithiasis were introduced into medical image three-dimensional visualization system （MI-3DVS） for three-dimensional reconstruction, 3D classifications of hepatolithiasis were obtained based on it. Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology. Results The 26 patients （29 times） experienced targeting treatment of rigid choledochoscope and pneumatic lithotripsy under the guidance of three-dimensional visualization technology, including ： 19 cases （4 cases of type [[ c ） through percutaneous biliary tract sinus, laparoscopic surgery 3 cases, laparotomy 4 cases. Three patients underwent surgery twice. The final stone clearance rate was 100%. One case confirmed combined with cholangiocarcinoma and transfer to radical resection. Intraoperative blood loss was （41.7 ± 8.5） ml, operating time was （ 100. 8 ± 7.6 ） minutes, and postoperative hospital stay was （7.0 ± O. 6） days. A patient suffered postoperative biliary tract bleeding. Without bile duct injury, bleeding, bile leakage and other complications were occurred. Conclusion Rigid choledochoscope and pneumatic lithotripsy in the treatment of hepatolithiasis under the guidance of three-dimensional visualization technology achieved digital minimally invasive treatment of hepatolithiasis, which can be a new approach to hepatobiliarv surgery.

关 键 词：胆结石 碎石术 成像 三维 

分 类 号：R657.4[医药卫生—外科学]