三维重建引导手术治疗复杂肝胆管结石的临床研究

Surgical treatment of complicated hepatolithiasis guided by 3D reconstruction

目的探讨三维重建引导手术治疗复杂肝胆管结石的应用价值和近期疗效.方法回顾性分析2011年1月至2019年6月湖南省人民医院肝胆外科三维重建引导手术治疗的56例复杂肝胆管结石患者的临床资料.结果本组患者均在三维重建引导下成功进行手术,配合术中胆道镜取石,平均历时210.3 min,平均失血量350.6 ml.按照Clavien-Dindo评分系统,Ⅰ级并发症36例,Ⅱ级并发症5例,无Ⅲ级以上并发症.56例患者术后经过平均3.6年(5个月至8年)的门诊、电话随访,仅有1例胆肠内引流术后的患者发生反流性胆管炎.术后残石率为68.8%,残石仅限于终末支胆管,患者生活质量较好.结论三维重建引导手术治疗复杂肝胆管结石近期疗效满意.

Objective To evaluate short-term therapeutic effect of surgical treatment for complicated hepatolithiasis under the guidance of 3 D reconstruction.Methods We retrospectively analyzed the clinical data of 56 patients with complicated hepatolithiasis undergoing surgical treatment with the guidance of 3D reconstruction at the Department of Hepatobiliary Surgery of Hunan Province People's Hospital from Jan 2011 to Jun 2019.Results All the patients were successfully operated on under the guidance of three-dimensional reconstruction and extraction of residual stones by choledochoscope.The average duration of operation was 210.3 minutes and the average blood loss was 350.6 ml.According to the scoring system of Clavien-Dindo,Grade I complications occurred in 36 cases,Grade II complications in 5 cases and there were no complications of Grade HI or higher.As found by an average follow-up of 3.6 years(range from 5 months to 8 years),only one patient had reflux cholangitis.Although the rate of residual stone was 68.8%,most stones remained only in the end branch of bile duct,hence do not interfere much with the patients'living status.Conclusions The surgical treatment with the guidance of 3D reconstruction is of satisfactory short-term curative effect in complicated hepatolithiasis.