摘要
目的评估Dyna CT胆道三维重建与CT影像融合技术引导的经皮经肝Ⅰ期胆道造瘘(PTOBF)取石手术治疗复杂肝胆管结石的疗效。方法回顾分析广州医科大学附属第一医院2022年5月至10月收治的18例复杂肝胆管结石患者资料,其中男性7例,女性11例,年龄(50.6±14.9)岁。所有患者均完成Dyna CT胆道三维重建与CT影像融合,并在融合影像和B超引导下行PTOBF取石手术。观察术前影像学显示结石所在胆管、术中取出结石所在胆管、理想每胆管取石时间、实际每胆管取石时间、再次手术取石、CT阴性结石、术后并发症等。结果18例复杂肝胆管结石患者在融合影像中发现95处胆管存在结石,肝内Ⅰ、Ⅱ、Ⅲ级胆管均发现结石。仅CT影像发现29处Ⅰ、Ⅱ级胆管存在结石。融合影像检出CT阴性结石5例。合并胆管狭窄12例。所有手术均顺利完成,无胆漏、胆道出血等并发症。术中实际82处肝胆管结石被取出,取石时间(25.9±12.8)min,理想每胆管取石时间(10.1±7.6)min,实际每胆管取石时间(10.5±7.4)min。结石取净13例,术后发生胆道感染2例,再次手术取石5例。结论Dyna CT胆道三维重建与CT影像融合技术引导的PTOBF取石手术治疗复杂肝胆管结石,能有效检出更多结石,缩短取石时间,为肝胆管结石病的治疗提供了新的策略。
Objective To evaluate the technical approach and application value of DynaCT biliary reconstruction with CT images fusion(DynaCT-CT fusion)for the treatment of complex hepatolithiasis.Methods The data of 18 patients with complex hepatolithiasis admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2022 to October 2022 were retrospectively analyzed,including 7 males and 11 females,aged(50.6±15.0)years.Preoperative DynaCT biliary reconstruction with CT images fusion was performed to guide the percutaneous transhepatic one-step biliary fistulation(PTOBF).The technical data,including the bile duct with stones identified by preoperative imaging,the actual bile duct with stones confirmed intraoperatively,the satisfied stone removal time for each targeted bile duct,the actual stone removal time for each targeted bile duct,the intraoperative identification of CT-negative stones,the postoperative complications and reoperation were analyzed.Results In 18 patients,a total of 95 target bile ducts with stones were identified by preoperative DynaCT-CT fusion technology,involving the first,secondary and tertiary bile ducts.Preoperative CT identified 29 lesions of stones involving the first and secondary bile ducts.CT negative stones were confirmed in 5 patients by DynaCT-CT fusion.Bile duct stricture occurred in 12 patients.All procedures were completed without postoperative bile leakage or hemorrhage.A total of 82 lesions of stones were successfully removed with a removal time of(25.9±12.8)min.The satisfied stone removal time for each targeted bile duct was(10.1±7.6)min,and the actual stone removal time was(10.5±7.4)min.Immediate stone clearance was achieved in 13 patients.Biliary tract infection occurred in 2 patients,and 5 patients underwent reoperation for residual or recurrent stones.Conclusion The DynaCT-CT fusion technology guided PTOBF is feasible and safe in patients with complex hepatolithiasis.It could effectively detect more stones,shorten the stone clearance time.DynaCT-CT fusion te
作者
叶永青
林杰龙
鄢磊
钟云龙
梁青
丁兆伟
王平
Ye Yongqing;Lin Jielong;Yan Lei;Zhong Yunlong;Liang Qing;Ding Zhaowei;Wang Ping(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2023年第9期655-658,共4页
Chinese Journal of Hepatobiliary Surgery
基金
广东省科技计划项目(2017ZC0222)
广州市科技计划项目(201803010065、202102010251)。
关键词
胆石
经皮经肝Ⅰ期胆道造瘘
影像融合
临床效果
Gallstones
Percutaneous transhepatic one-step biliary fistulation
Images fusion
Clinical effect
