精准肝切除联合电子胆道镜在肝胆管结石治疗中的应用

Precise hepatectomy combined with electronic choledochoscope in the treatment of hepatolithiasis

目的 探讨精准肝切除联合电子胆道镜在肝胆管结石治疗中的应用价值.方法 回顾性分析2012年1月至2014年5月66例肝胆管结石患者的资料,术前利用可视化三维重建进行精确评估,采用精准肝切除联合电子胆道镜技术祛除病灶.结果 全部患者手术均成功完成,三维重建对胆管、结石及周围重要血管的解剖学评估结果与术中所见大致相符,术前预切除肝脏体积与术中实际切除肝脏体积呈正相关（r =0.945,P＜0.05）.平均手术时间（221±65） min,平均出血量（267±78） ml.术后并发症8例（12％）.随访时间为6～30个月,疗效优良,随访发现残留结石5例（8％）,2例（3％）复发.结论 精准肝切除联合电子胆道镜的应用是治疗肝胆管结石有效、安全、微创的方法,具有较好的临床应用价值.

Objective To investigate the clinical value of precise hepatectomy combined with electronic choledochoscope in the treatment of hepatolithiasis.Method Clinical data of 66 patients with hepatolithiasis from January 2012 to May 2014 were retrospectively analyzed.The preoperative accurate evaluation was achieved by using 3D reconstruction,and the precise hepatectomy combined with cholangioscopy removed the hepatic lesions.Result Operations were successfully completed in all patients.The anatomic evaluation results of visualization of 3D reconstruction on biliary duct,stone and vascular and surgical findings were broadly consistent.The liver volumes of pre resection and actual resection were positively correlated （r =0.945,P ＜ 0.05）.The average operation time was （221 ± 65） min,the average amount of bleeding was （267 ± 78） ml.Postoperative complications occurred in 8 cases （12％）.Patients were followed up from 3 to 20 months;Residual stones were found in 5 cases （8％）,2 cases suffered from stone recurrence （3％）.Conclusions Precise liver resection combined with electronic choledochoscope in the treatment of hepatolithiasis is an effective,safe,minimally traumatic therapy.