摘要
目的探讨三维可视化技术在肝门部胆管癌患者行经内镜胆管内支架放置术(endoscopic retrograde biliary drainage,ERBD)精准引流中的临床价值。方法回顾性收集2019年9月—2022年8月青海大学附属医院经影像学评估高度怀疑为肝门部胆管癌而行ERBD的42例患者临床资料,其中20例患者术前行三维胆道重建(重建组),22例患者术前未行三维胆道重建(非重建组)。比较两组患者在手术时长、透视时长、技术成功率、临床成功率、术后并发症发生率、近期和短期内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)再干预率等方面的差异。结果两组患者术前基线资料差异无统计学意义(P>0.05)。42例患者均成功进行ERBD。重建组手术时长[35.00(25.00,57.50)min]明显低于非重建组[60.00(33.75,60.00)min],差异有统计学意义(Z=-2.251,P=0.024)。两组透视时长[10.00(5.00,12.00)min比10.55(9.50,17.50)min]比较差异无统计学意义(Z=-1.552,P=0.121)。两组患者技术成功率均为100.0%,重建组临床成功率高于非重建组[70.0%(14/20)比31.8%(7/22)],差异有统计学意义(χ^(2)=6.109,P=0.013)。两组术后并发症发生率[20.0%(4/20)比22.7%(5/22)]差异无统计学意义(χ^(2)=0.141,P=0.708)。所有患者术后随访6个月,其中重建组中位生存时间为3.91个月,非重建组为2.78个月。术后2周内重建组无ERCP再干预,而非重建组4例(18.2%)因胆管炎及术后胰腺炎进行了6次ERCP干预。2周至3个月内重建组2例(10.0%)因胆管炎进行了4次ERCP干预,非重建组2例(9.1%)因胆管炎进行了3次ERCP干预。重建组与非重建组在近期(χ^(2)=2.183,P=0.140)及短期ERCP再干预率(χ^(2)=0.000,P=1.000)方面差异无统计学意义。结论三维可视化胆道重建技术通过术前精准规划,可对肝门部胆管癌患者进行预引流肝体积的测算,缩短手术时间,提高临床成功率,值得推广。
Objective To investigate the clinical value of three-dimensional(3D)visualization technology in the precise drainage through endoscopic retrograde biliary drainage(ERBD)for hilar cholangiocarcinoma.Methods Clinical data of 42 patients with highly suspected hilar cholangiocarcinoma who underwent ERBD in Qinghai University Affiliated Hospital from September 2019 to August 2022 were retrospectively collected.Twenty patients underwent 3D biliary tract reconstruction before surgery(the reconstruction group)and 22 others did not undergo 3D biliary tract reconstruction before surgery(the non-reconstruction group).The surgery time,X-ray exposure time,the technical success rate,the clinical success rate,incidence of postoperative complications,recent and short-term endoscopic retrograde cholangiopancreatography(ERCP)reintervention rate of the two groups were compared.Results There was no significant difference in preoperative baseline data between the two groups(P>0.05).ERBD was conducted successfully in all 42 patients.The operation time in the reconstruction group[35.00(25.00,57.50)min]was significantly shorter than that in the non-reconstruction group[60.00(33.75,60.00)min]with significant difference(Z=-2.251,P=0.024).There was no significant difference in the X-ray exposure time between the two groups[10.00(5.00,12.00)min VS 10.55(9.50,17.50)min,Z=-1.552,P=0.121].The technical success rates of both groups were 100.0%,and the clinical success rate of the reconstruction group was higher than that of the non-reconstruction group[70.0%(14/20)VS 31.8%(7/22)]with significant difference(χ^(2)=6.109,P=0.013).There was no significant difference in the incidence of postoperative complications between the two groups[20.0%(4/20)VS 22.7%(5/22),χ^(2)=0.141,P=0.708].All patients were followed up for 6 months after the procedure.The median survival time was 3.91 months in the reconstruction group and 2.78 months in the non-reconstruction group.There was no ERCP intervention in the reconstruction group within 2 weeks after the proce
作者
严积灿
于文昊
王志鑫
孔繁玉
谢智
樊海宁
王海久
卢倩
任利
Yan Jican;Yu Wenhao;Wang Zhixin;Kong Fanyu;Xie Zhi;Fan Haining;Wang Haijiu;Lu Qian;Ren Li(Department of Critical Care Medicine,Qinghai University Affiliated Hospital,Xining 810001,China;Department of Hepatobiliary and Pancreatic Surgery,Qinghai University Affiliated Hospital,Xining 810001,China;Hepatobiliary and Pancreatic Center,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 100000,China)
出处
《中华消化内镜杂志》
CSCD
2023年第9期713-718,共6页
Chinese Journal of Digestive Endoscopy
基金
国家重点研发计划(2017YFC0909900)
青海省科技厅项目(2020-ZJ-Y01)青海省“昆仑英才·高原名医”项目。
关键词
肝门胆管肿瘤
胰胆管造影术
内窥镜逆行
三维可视化技术
胆道
Klatskin tumor
Cholangiopancreatography,endoscopic retrograde
Three dimensional visualization technique
Biliary tract
