数字化微创技术在肝胆管结石诊治中的应用研究

Application of Digital Technology Assisted Minimally Invasive Surgery in Diagnosis and Treatment of Hepatolithiasis

目的探讨数字化微创技术在肝胆管结石诊治中的临床应用价值。方法采集5例复杂肝胆管结石患者的64排多层螺旋CT原始数据,导入腹部医学图像三维可视化系统(MI-3DVS)中,三维重建肝脏、肝内管道系统、结石以及上腹腔脏器和血管。根据三维重建图像,观察结石的形态、大小及空间分布,扩张及狭窄胆管的分布及其与周围血管的空间解剖关系,制定合理肝脏切除范围及吻合方式的微创手术规划;术前进行不同手术方案的仿真手术演练,达到最小程度组织损伤,指导术中实际操作。结果 经MI-3DVS成功完成5例患者肝脏、胆道系统、结石、血管以及上腹腔脏器的三维重建,并清晰显示结石的大小、数量、形态、空间位置以及胆管狭窄的位置、程度、长度及其周围血管的空间解剖关系。三维重建结果与术中所见均符合,实际手术操作入路与仿真手术相同。手术顺利,无手术并发症。术后1个月经T管或相应支撑管造影复查未见肝内、外胆管残留结石。结论 数字化三维重建及个体化仿真手术对实现复杂肝胆管结石微创诊治具有重要的指导意义。

Objective To study the clinical value of digital technology assisted minimally invasive surgery in diagnosis and treatment of hepatolithiasis.Methods The image data of 64-slice spiral CT scanning were obtained from five patients of complicated hepatolithiasis and introduced into medical image three-dimensional visualization system（MI-3DVS） for three-dimensional reconstruction.On the basis of the data of three-dimensional reconstruction,minimally invasive surgical planning of preoperation was made to obtain reasonable hepatectomy and cholangiojejunostomy,and then preoperative emulational surgery was carried out to minimize the extent of tissue damage and provide guidance to actual operation.Results Liver,biliary system,stone,blood vessel,and epigastric visceral organ were successfully reconstructed by MI-3DVS,which showed clearly size,number,shape,and space distribution of stone,and location,degree,length,and space distribution of biliary stricture,and anatomical relationship of ducts and vessels.The results of three-dimensional reconstruction were successfully confirmed by actual operation,which was in accordance with emulational surgery.There was no operative complication.No retained stone in internal and external bile duct was found by T-tube or other supporting tube cholangiography on one month after operation.Conclusion Three-dimensional digitizing reconstruction and individual emulational surgery have important significance in diagnosis and treatment of complicated hepatolithiasis by minimally invasive technique.