摘要
目的总结3D成像系统在复杂肝胆管结石病诊治中的应用价值。方法复杂肝胆管结石病人40例。在多层螺旋CT(MDCT)及磁共振胰胆管成像(MRCP)基础上进行3D评估、手术规划,并模拟手术以指导实际手术过程。比较术中所见与术前评估的符合程度、手术方式及其与手术规划的符合程度、手术时间、术中出血量、并发症发生率及围手术期病死率。结果 40例病人均成功获得3D评估。术中所见与术前3D图像吻合,实际手术方案与手术规划符合率97. 5%(39/40)。1例拒绝行肝叶/段切除术,3例左右肝胆管广泛结石,余36例术后经胆道造影或B超证实无结石残余。1年结石复发率8. 3%(3/36)。结论 3D成像系统可清晰显示肝内外结石的分布以及与胆道系统、毗邻肝组织和血管的空间位置关系,有利于复杂肝胆管结石病术前精准评估和制定出个体化、合理化的手术方案。
Objective To explore the application value of the three-dimensional( 3 D) imaging system in the diagnosis and treatment of complex hepatolithiasis. Methods The clinical data of 40 cases of complex hepatolithiasis were analyzed retrospectively. 3 D evaluation,surgical planning and simulated operation were conducted on the basis of MDCT and MRCP to guide the actual operation. Statistical analysis was performed to compare the consistency between the intraoperative and the preoperative evaluation,the actual surgical protocols and its compliance with the preoperative surgical planning,the operative time,the intraoperative blood loss,the incidence of complications and the perioperative mortality. Results The3 D-images of all 40 cases were successfully obtained. The intraoperative findings were consistent with the preoperative 3 D images,and the consistency between the actual surgical plan and the surgical planning was 97. 5%( 39/40). 1 patient refused to undergo lobectomy and 3 patients had extensive choledocholithiasis. 36 cases were confirmed to be free of stone remnants by cholangiography or B-ultrasonography after operation. The recurrence rate of stones in 1 year was 8. 3%( 3/36). Conclusion The 3 D evaluation system can clearly show the distribution of intrahepatic stones and the spatial relationship with the biliary system,adjacent liver tissue and blood vessels,which is conducive to the preoperative accurate evaluation of complex hepatolithiasis and the formulation of individualized and reasonable surgical plans.
作者
邓正栋
杨涛
王剑明
DENG Zhengdong;YANG Tao;WANG Jianming(Department of Genral Surgery,Tonal Hospital,Tonal Medical College,Huazhong University of Science and Technology, Wuhan 430030,China)
出处
《临床外科杂志》
2018年第12期929-931,共3页
Journal of Clinical Surgery
关键词
3D成像系统
复杂肝胆管结石
精准评估
术前规划
three-dimensional evaluation system
complex hepatolithiasis
accurate assessment
preoperative planning
