摘要
目的探讨术中多影像融合介入导航系统(RVS)在复杂肝胆管结石病诊断与治疗中的应用价值。方法采用回顾性描述性研究方法。收集2017年10月至2018年3月湖南省人民医院收治的10例复杂肝胆管结石病患者的临床资料;男3例,女7例;平均年龄为57岁,年龄范围为40~69岁。患者术前均行腹部(肝胆胰脾)彩色多普勒超声、磁共振胰胆管成像及上腹部薄层螺旋CT平扫+增强检查。CT检查数据导入RVS。采用RVS定位结石、结石与大血管关系、胆管以及肝门部血管解剖结构,手术采用RVS引导下行包括肝门部胆管切开术、狭窄胆管切开整形术、肝胆管盆式内引流术、肝叶(段)切除术、肝实质切开取石术等多种组合手术方式。观察指标:(1)手术及术后情况。(2)典型病例分析。(3)随访情况。采用门诊方式进行术后随访,了解患者结石残留情况。随访时间截至2019年6月。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术及术后情况:10例患者均成功在RVS引导下行复杂肝胆管结石病手术,RVS配对均获成功(CT检查影像与超声影像差距<2 mm)。术中均通过胆道镜证实取净结石,无残留。10例患者手术时间为285 min(210~360 min),术中出血量为200 mL(100~600 mL),无输血患者,住院时间为20.5 d(14.0~29.0 d),无围术期死亡。1例患者术后并发胆汁漏和腹腔感染,经保守治疗后痊愈。(2)典型病例分析:病例10,女,60岁,术前影像学检查提示复杂肝胆管结石病,拟行肝实质切开取石+肝方叶切除肝门胆管整形+盆式内引流术。将患者术前CT检查图像与术中彩色多普勒超声图像进行融合配对,配对层面为门静脉矢状部横切面和门静脉右支横切面,并在图像上标记结石以及重要管道。准确定位后采用刮匙进行取石。在肝脏表面结石感明显处切开肝实质及末梢扩张胆管取石,取出结石后经该肝内胆管与肝门部胆
Objective To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis.Methods The retrospective and descriptive study was conducted.The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected.There were 3 males and 7 females,aged from 40 to 69 years,with an average age of 57 years.Patients received abdominal color Doppler ultrasound examination,magnetic resonance cholangiopancreatography,and upper abdominal spiral computed tomography(CT)thinly scanning+enhanced examination.Data of CT examination were imported into RVS.RVS was used to locate hepatolithiasis,relationship between stones and vessels,anatomy of bile ducts and vessels in hepatic hilus.Surgical methods included RVS-guided hilar cholangiotomy,biliary stricturoplasty,bilateral hepatojejunostomy,hepatic segmentectomy(lobectomy),and hepatolithotomy.Observation indicators:(1)surgical and postoperative situations;(2)typical case analysis;(3)follow-up.Follow-up using outpatient examination was performed to detect residual stones up to June 2019.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical and postoperative situations:10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis,with successful match in RVS(difference between CT images and ultrosound images<2 mm).No residual stone was identified by choledochoscope during operation.The operation time and volume of intraoperative blood loss were 285 minutes(range,210-360 minutes)and 200 mL(range,100-600 mL),respectively.No blood transfusion was needed during the operations.The duration of hospital stay was 20.5 days(range,14.0-29.0 days).There was no perioperative death.One patient had postoperative biliary leakage and abdominal infection,and was cured after conservative treatment.(2)Typical case analysis:the te
作者
肖彦
周磊
成伟
黄生桃
刘雅玲
李国光
杨建辉
潘小季
王湘英
Xiao Yan;Zhou Lei;Cheng Wei;Huang Shengtao;Liu Yaling;Li Guoguang;Yang Jianhui;Pan Xiaoji;Wang Xiangying(Department of Surgical Intensive Care Unit,the First Hospital Affiliated to Hunan Normal University,Hunan Provincial People′s Hospital,Changsha 410005,China;Department of Hepatobiliary Surgery,the First Hospital Affiliated to Hunan Normal University,Hunan Provincial People′s Hospital,Changsha 410005,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2020年第1期99-105,共7页
Chinese Journal of Digestive Surgery
基金
湖南省自然科学基金面上项目(2017JJ2159)
长沙市科技局一般项目(KQ1701051)。
