摘要
目的 探讨肝胆管结石经三维可视化辅助3D腹腔镜、胆道硬镜靶向碎石治疗的临床疗效。方法 回顾性分析2012年1月至2017年6月行腹腔镜、胆道硬镜靶向碎石治疗的98例肝胆管结石患者资料,按照手术方式不同分为3D腹腔镜组(3D组, n =46)和普通腹腔镜组(2D组, n =52)。采用SPSS 21.0对数据进行分析。术中、术后各项定量指标采用(±s)描述,独立t检验;结石清除率、术后结石复发率、胆管炎复发率、并发症发生率等组间比较采用Pearson χ 2检验。P <0.05为差异有统计学意义。结果 3D组术前三维可视化重建情况与术中所见基本符合,实际手术方案与仿真手术方案符合率100%。3D组的手术时间、术中出血量、输血量、结石清除率和术后住院时间显著优于2D组( P <0.05)。术后随访(12.2±2.8)个月,3D组的结石复发率(0%)、总体并发症发生率(4.3%)显著低于2D组(9.6%,19.2%)( P <0.05)。结论 三维可视化辅助3D 腹腔镜、胆道硬镜肝胆管结石靶向碎石术实现了对肝胆管结石安全有效的微创治疗,能实现精准术前诊断,优化手术方案,提高结石清除率、减少术后并发症和结石复发,具有临床应用价值。
Objective To investigate the effect of 3D laparoscope combined with rigid choledochoscope targeting lithotripsy in the treatment of hepatolithiasis under the assistance of 3D visualization technology. Methods 98 cases of hepatolithiasis treated in our hospital from January 2012 to June 2017 were retrospectively analyzed. According to different surgical methods, the patients were divided into 3D laparoscope group (3D group, n =46) and common laparoscope group (2D group, n =52). SPSS 21.0 was used to analyze. Quantitative indices during and after operation were described by (±s) and compared by independent t test;Pearson χ 2 test was used to compare stone clearance rate, recurrence rate of postoperative stone, recurrence rate of cholangitis and complication rate between groups. P <0.05 was statistically significant. Results The preoperative 3D visualization reconstruction of the 3D group group was basically consistent with the intraoperative findings, and the coincidence rate between the actual operation plan and the simulation operation plan was 100%. The operation time, intraoperative bleeding volume , blood transfusion volume, stone clearance rate and postoperative hospitalization time of the 3D group group were significantly better than those of the 2D group group ( P <0.05). The recurrence rate (0%) and overall complication rate (4.3%) of the 3D group group were significantly lower than those (9.6%, 19.2%) of the 2D group ( P <0.05). Conclusion 3D visualization assisted 3D laparoscopy and rigid choledochoscope for hepatolithiasis is a safe and effective minimally invasive treatment for hepatolithiasis. It can realize accurate preoperative diagnosis, optimize operation scheme, improve stone clearance rate, and reduce postoperative complications and recurrence of stones.
作者
韩云
韩莉
杨生虎
杨立平
李晓峰
Han Yun;Han Li;Yang Shenghu;Yang Liping;Li Xiaofeng(Abdominal lens surgery, Affiliated Hospital of Qinghai University, 810001)
出处
《中华普外科手术学杂志（电子版）》
2019年第5期504-506,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
结石
胆管
肝内
腹腔镜
成像
三维
Calculi
Bile ducts, intrahepatic
Laparoscopes
Imaging, three-dimensional
