三维可视化技术引导的经皮经肝Ⅰ期胆道造瘘取石术在复杂肝内胆管结石中的应用  

Three-dimensional visualization technology in one-stage establishment of a percutaneous transhepatic biliary tract in treatment of complex hepatolithiasis

作　　者：王平[1] 曹亚文 孙北望[1] 周兴华[1] 周大治[1] Wang Ping;Cao Yawen;Sun Beiwang;Zhou Xinghua;Zhou Dazhi(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院肝胆外科,广州510120

出　　处：《中华肝胆外科杂志》2021年第7期509-512,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省科技计划项目(2017ZC0222);广州市科技计划项目(201803010065,202102010251)。

摘　　要：目的探讨三维可视化技术引导的经皮经肝Ⅰ期胆道造瘘(3D-PTOBF)取石手术在复杂肝内胆管结石治疗中的临床应用价值。方法回顾分析广州医科大学附属第一医院2016年1月至2019年12月收治的116例复杂肝内胆管结石患者临床资料,其中男性46例,女性70例,年龄(54.9±12.9)岁。依据取石手术方式不同,分为3D-PTOBF取石组(n=56)和传统经皮经肝Ⅰ期胆道造瘘(PTOBF)取石组(n=60)。比较两组结石清除率、术后并发症、胆道镜取石次数、术后住院时间、结石复发率等。结果两组即刻结石清除率和最终结石清除率比较,差异无统计学意义(均P>0.05)。3D-PTOBF取石组术后住院时间(4.6±2.3)d、胆道镜取石次数(1.43±0.71)次,均低于传统PTOBF取石组(6.1±2.9)d、(2.07±1.22)次,差异有统计学意义(均P<0.05)。3D-PTOBF取石组术后并发症发生率10.7%(6/56)、复发率10.7%(6/56),传统PTOBF取石组分别为13.3%(8/60)、13.3%(8/60),两组术后并发症发生率和复发率比较差异无统计学意义(均P>0.05)。结论3D-PTOBF取石手术治疗复杂肝内胆管结石是安全可行的,相较于传统PTOBF取石,具有手术次数少、住院时间短的优点。Objective To study the use of percutaneous transhepatic one-step biliary fistulation based on three-dimensional visualization technology(3D-PTOBF)in the treatment of complex hepatolithiasis.Methods A retrospective analysis was conducted on 116 patients with complex hepatolithiasis treated in the First Affiliated Hospital of Guangzhou Medical University from January 2016 to December 2019.There were 56 patients in the 3D-PTOBF group(treated by 3D-PTOBF),and 60 patients in the traditional PTOBF group(received traditional PTOBF approach).The stone clearance rate,postoperative complication rate,intraoperative blood loss,hospitalization time,number of cholangioscopic treatment procedures and stone recurrence rate were compared between the two groups.Results When compared with the traditional PTOBF group,the 3D-PTOBF group had significantly less procedures(1.43±0.71 vs.2.07±1.22,P<0.05),and shorter hospital stay(4.6±2.3 d vs.6.1±2.9 d,P<0.05).There were no significant differences in the immediate stone clearance,final stone clearance,postoperative complications and stone recurrence rates between the two groups(all P>0.05).Conclusion 3D-PTOBF was safe and feasible to treat complex hepatolithiasis.When compared with PTOBF,it had the advantages of shorter operation time and decreased hospital stay.

关 键 词：胆石 成像 三维 经皮经肝Ⅰ期胆道造瘘 

分 类 号：R657.4[医药卫生—外科学]