计算机三维重建技术在指导硬胆道镜治疗复杂性肝胆结石中的应用

Application of computerized three-dimensional reconstruction in guiding rigid choledochoscopy in the treatment of complicated hepatobiliary stones

目的:探讨计算机三维重建技术在指导硬胆道镜治疗复杂性肝胆结石中的应用价值。方法:回顾性分析2017年5月~2020年1月本院收治的110例复杂性肝胆结石患者临床资料,按照手术治疗方式,将采用三维可视化技术引导下硬胆道镜手术治疗的患者59例纳入A组,将采用常规硬胆道镜手术治疗的复杂性肝胆管结石患者51例纳入B组,观察患者围术期指标、结石清除率与复发率、应激反应指标、肝功能指标以及术后并发症发生情况。结果:A组手术时间、术后住院时间短于B组,术中出血量少于B组;两组术后排气时间比较;A组结石残余率低于B组;两组随访1年结石复发率比较;A组术后第2d血清应激反应指标白细胞计数(WBC)、中性粒细胞计数(NEUT)、皮质醇(COR)、肾上腺素(EP)水平低于B组;A组术后1个月肝功能指标天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、 碱性磷酸酶(ALP)、总胆红素(TBIL)水平低于B组;两组术后并发症发生率比较。结论:计算机三维重建技术指导硬胆道镜治疗复杂性肝胆结石可缩短手术时间,减少术中出血量,减轻患者氧化应激反应,加快患者术后恢复进程,结石清除率高。

Objective To explore the application value of computerized three-dimensional reconstruction in guiding rigid choledochoscopy in the treatment of complex hepatobiliary stones.Methods A retrospective analysis was performed on the clinical data of 110 patients with complicated hepatobiliary stones admitted to the hospital between May 2017 and January 2020.According to different treatment methods,59 cases treated with rigid choledochoscopy under the guidance of three-dimensional visualization technology were included in group A,while other 51 cases treated with routine rigid choledochoscopy were included in group B.The perioperative indexes,clearance and recurrence rates of stones,stress response indexes,liver function indexes and postoperative complications were observed.Results The operation time and postoperative hospitalization time in group A were shorter than those in group B,and intraoperative blood loss was less than that in group B.The difference in postoperative exhaust time between the two groups was not statistically significant.The residual rate of stones in group A was lower than that in group B.The difference in recurrence rate of stone between the two groups was not statistically significant during 1-year follow-up.At 2d after surgery,levels of serum stress response indexes [white blood cell count (WBC),neutrophil count (NEUT),cortisol (COR),epinephrine (EP)]in group A were lower than those in group B.At 1 month after surgery,levels of liver function indexes [aspartate aminotransferase (AST),alanine aminotransferase (ALT),alkaline phosphatase (ALP),total bilirubin (TBIL)]in group A were lower than those in group B.The difference in incidence of postoperative complications between the two groups was not statistically significant.Conclusion The application of computerized three-dimensional reconstruction in guiding rigid choledochoscopy in the treatment of complicated hepatobiliary stones can shorten operation time,reduce intraoperative blood loss,alleviate oxidative stress response and accelerate postoperative recovery,with high stone clearance rate.