3D打印模型结合经皮肝Ⅰ期胆道造瘘术联合硬质胆道镜手术治疗肝内胆管结石的临床效果

Clinical application of 3D printing model for percutaneous transhepatic one⁃step biliary fistulation and rig⁃id choledochoscopy in patients with intrahepatic cholangiolithiasis

目的研究3D打印模型结合经皮肝Ⅰ期胆道造瘘联合硬质胆道镜手术治疗Ⅰ型胆管分型患者肝内胆管结石的疗效和安全性。方法选取40例I型胆管分型的肝内胆管患者手术治疗的临床资料,其中3D打印组共17例患者采用3D打印模型结合经皮肝Ⅰ期胆道造瘘联合硬质胆道镜手术方案;对照组共23例患者行单纯经皮肝Ⅰ期胆道造瘘联合硬质胆道镜手术。观察分析两组患者的一期手术时间、一期取净率、多期取石发生率、最终取净率、手术出血量、通道大小、并发症7项指标。结果3D打印组的患者一期取净率、最终取净率高于对照组,差异有统计学意义(P<0.05);3D打印组的患者多期取石发生率、一期手术时间、手术出血量和主要术后并发症低于对照组,差异有统计学意义(P<0.05)。两组间的通道大小差异无统计学意义(P>0.05)。结论3D打印模型结合经皮肝Ⅰ期胆道造瘘联合硬质胆道镜手术治疗肝内胆管结石,手术时间短,取石率高,并发症少,安全性高,具备临床应用价值。

Objective To evaluate the efficacy and safety of a 3D printing model combined with percuta⁃neous transhepatic one⁃step biliary fistula(PTOBF)and rigid choledochoscopy in the treatment of intrahepatic duct stones in patients with type I bile duct classification.Methods Clinical data of 40 patients with intrahepatic bile duct type I classification were analyzed.In experimental group,17 patients were treated with a 3D printing model combined with PTOBF and rigid choledochoscopy;23 patients in control group underwent simple PTOBF and rigid choledochoscopy.Seven indicators including primary operation time,primary removal rate,incidence of multi⁃phase lithotomy,final removal rate,amount of surgical bleeding,channel size,and complications in the two groups were observed and compared.Results The primary and final clearance rates of patients in the experimental group were higher than those in the control group(P<0.05).There were lower incidence of multi⁃phase lithotomy,reduced time of primary operation,less amount of bleeding and main postoperative complications in the experimental group,when compared those in the control group,showing statistical differences(P<0.05).There was no signifi⁃cant difference in channel size between the two groups(P>0.05).Conclusion There are shortened operation time,high stone removal rate and few complications with a 3D printing model combined with PTOBF and rigid choledochoscopy in the treatment of intrahepatic duct stones,which is safe and worth to be popularized in clinical practice.