三维可视化技术指导输尿管硬镜联合钬激光在复杂肝胆管结石病诊治中的应用  

Clinical application of rigid ureteroscope combined with holmium laser in diagnosis and treatment of complicated hepatolithiasis guided by three-dimensional visualization technology

作　　者：米杨 汪新天[1] 陈晨[2] 李浩[2] 何自力[2] 蒋超[2] 崔鹏 翁曦 王蕾 陈少秋 Mi Yang;Wang Xintian;Chen Chen;Li Hao;He Zili;Jiang Chao;Cui Peng;Weng Xi;Wang Lei;Chen Shaoqiu(Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410000,China;Laboratory of Hepatobiliary Molecular Oncology,Laboratory of Hepatobiliary Molecular Tumors,Hunan Provincial People's Hospital,Changsha,410000,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)胆道外二科,长沙410000 [2]湖南省人民医院肝胆分子肿瘤研究室,长沙410000

出　　处：《中国医师杂志》2020年第5期693-698,共6页Journal of Chinese Physician

基　　金：湖南省自然科学基金面上项目(2017JJ2152);湖南省技术创新引导计划——临床医疗技术创新引导项目(2018SK50708)。

摘　　要：目的探讨三维可视化技术指导输尿管硬镜联合钬激光在复杂肝胆管结石病诊治中的应用价值。方法选取2016年10月至2019年3月本院收治的50例复杂肝胆管结石病患者作为研究对象,根据入院时间先后分组。选取2016年10月至2018年4月基于传统影像学诊断方式行输尿管硬镜联合钬激光术的30例患者作为对照组,选取2018年5月至2019年3月三维可视化技术指导行输尿管硬镜联合钬激光术的20例患者作为观察组。统计分析两组在手术时间、术中出血量、结石残存率、术后住院时间、术后并发症发生率等方面的差异。结果观察组结石残留率为10%(2/20),对照组结石残留率为40%(12/30);观察组术中出血量(170.9±18.0)ml,对照组术中出血量(371.6±37.0)ml;观察组手术时间(179.0±14.3)min,对照组手术时间(340.2±24.3)min,组间差异均有统计学意义(P<0.05);观察组术后住院时间(8.3±1.5)d,对照组术后住院时间(10.1±1.8)d,差异无统计学意义(P>0.05)。观察组术后胆道出血者1例,胆漏者2例;对照组术后胆道出血者3例,胆漏者4例;两组并发症发生率差异无统计学意义(P>0.05)。结论三维可视化技术指导的输尿管硬镜联合钬激光术在复杂肝胆管结石病诊治中可进一步提高其手术疗效,值得在临床上推广应用。Objective To analysis the application value of rigid ureteroscope combined with holmium laser in diagnosis and treatment of complicated hepatolithiasis guided by three-dimensional visualization technology.Methods 50 patients with complex hepatolithiasis treated in Hunan People′s Hospital from October 2016 to March 2019 were selected as the study subjects.They were divided into observation group and control group by simple random method.20 cases underwent rigid ureteroscope combined with holmium laser under the guidance of three-dimensional visualization technology were taken as observation group,30 cases underwent rigid ureteroscope combined with holmium laser by traditional imaging diagnosis were taken as control group.The differences between the two groups in operation time,intraoperative bleeding volume,stone residual rate,postoperative hospital stay and postoperative complications were statistically analyzed.Results The residual rate of calculi in observation group was 10%(2/20),while it was 40%(12/30)in control group;the amount of bleeding during operation in the observation group was(170.9±18.0)ml,and it was(371.6±37.0)ml in the control group;the operation time of observation group was(179.0±14.3)minutes,and it was(340.2±24.3)minutes in the control group;the postoperative hospital stay of observation group was(8.3±1.5)days,and it was(10.1±1.8)days in the control group;postoperative biliary hemorrhage occurred in 1 cases of the observation group,biliary tract leakage occurred in 2 cases,postoperative biliary hemorrhage occurred in 3 cases of the control group,biliary tract leakage occurred in 4 cases.Conclusions Rigid ureteroscope combined with holmium laser guided by three-dimensional visualization technology can further improve the clinical efficacy in the diagnosis and treatment of complex hepatolithiasis.which is worthy of clinical application.

关 键 词：成像 三维 输尿管硬镜 钬激光 胆结石 

分 类 号：R657.4[医药卫生—外科学]