CT三维可视化指导腹腔镜精准肝段切除联合纤维胆道镜取石治疗复杂性肝胆管结石患者疗效研究

One-year follow-up of patients with complex hepatolithiasis after laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance

目的探讨CT三维可视化指导腹腔镜精准肝段切除联合纤维胆道镜取石治疗复杂性肝胆管结石患者的疗效。方法2016年1月~2022年12月我院肝胆外科收治的63例复杂性肝胆管结石患者,被分为两组,均接受腹腔镜肝段切除联合纤维胆道镜取石手术。观察组在术前对CT图像进行可视化、分割和放大处理,制定个体化肝段切除方案。术后随访1年。结果观察组手术时间、术中出血量和术后住院日分别为101.8(96.4,117.6)min、(25.9±6.7)mL和(9.6±1.5)d,均显著短于或少于对照组【分别为121.3(98.5,135.4)min、(37.7±15.9)mL和(11.9±2.7)d,P<0.05】,而两组肠功能恢复时间无显著性差异【(2.6±0.3)d对(2.8±0.6)d,P>0.05】;术后,观察组血清总胆红素、白蛋白和碱性磷酸酶水平分别为(15.6±8.4)μmol/L、(35.6±2.3)g/L和(78.1±21.2)U/L,与对照组【分别为(17.1±1.4)μmol/L、(36.8±2.7)g/L和(99.2±21.3)U/L】比,无显著性差异(P>0.05);术后,观察组切口感染、胆道出血、胆道损伤和胆漏发生率为16.1%,显著低于对照组的53.1%(P<0.05);在术后2周复查,观察组结石清除率为96.8%,显著高于对照组的75.0%(P<0.05),术后随访1年,经超声或CT检查发现观察组肝内结石复发率为3.2%,显著低于对照组的18.8%(P<0.05)。结论术前,应用CT三维可视化技术分析结石侵犯范围,拟定手术方案,行肝段切除治疗复杂性肝胆管结石患者可减少并发症发生率,提高结石清除率,降低结石复发率,有很大的实用意义。

Objective The aim of this study was to observe the efficacy of laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance in the treatment of patients with complex hepatolithiasis.Methods 63 patients with complex hepatolithiasis were encountered in our hospital between January 2016 and December 2022,were divided into observation and control groups,and all patients underwent segmental hepatectomy and fiberoptic cholangioscopy.In the observation group,the CT three-dimensional visualization technology was applied to personally reveal,design operation plan and mimic the operation pre-operationally.All patients were followed-up for one year.Results The surgical time,intraoperative blood loss and hospital stay after operation in the observation group were 101.8(96.4,117.6)min,(25.9±6.7)mL and(9.6±1.5)d,all significantly shorter or less than[121.3(98.5,135.4)min,(37.7±15.9)mL and(11.9±2.7)d,respectively,P<0.05]in the control,while there was no significant difference as respect to recovery of intestinal functions in the two groups[(2.6±0.3)d vs.(2.8±0.6)d,P>0.05];post-operationally,total serum bilirubin,albumin and ALP levels in the observation group were(15.6±8.4)μmol/L,(35.6±2.3)g/L and(78.1±21.2)U/L,all not significantly different compared to[(17.1±1.4)μmol/L,(36.8±2.7)g/L and(99.2±21.3)U/L,P>0.05]in the control;the incidence of complications,such as incision infection,biliary bleeding,biliary injury and biliary leakage in the observation was 16.1%,much lower than 53.1%(P<0.05)in the control;two weeks after surgery,the imaging showed that the stone clearance rate in the observation group was 96.8%,much higher than 75.0%(P<0.05)in the control,and at the end of one-year follow-up,the imaging demonstrated that the stone recurrence rate in the observation group was 3.2%,much lower than 18.8%(P<0.05)in the control group.Conclusion The laparoscopic precision liver segment resection under CT three-dimensional visualization technology guidance in the treatment of patients with complex hepatolithiasis is efficacious,which could improve stone clearance rate,with less complications and low stone recurrence,and warrants further clinical exploration.