目的 探讨数字胆道系统在复杂胆石症微创手术中的临床应用价值。 方法 纳入2018年4月至2019年7月间收治的复杂胆石症病人41例，随机分为实验和对照两组，实验组进行肝胆建模，导入数字胆道系统，应用于术前评估、手术仿真、制订碎石取石方案和术中指导；两组均采用微创手术。超声或CT复查结石残留和复发情况。 结果 实验组术中所见胆道及结石均与数字胆道系统中所见吻合，手术方式与术前模拟、规划均一致；手术时间（160.10±78.82）min，术中出血量（2.95±2.28）ml，肠道恢复时间（1.13±0.70）d，均少于对照组，无围手术期严重并发症；无结石残留和复发。对照组有2例结石残留，1例消化道出血和2例结石复发。 结论 数字胆道系统对于复杂胆石症微创手术有较好的指导意义和应用价值，能减少术中出血，缩短手术时间和肠道恢复时间，安全高效。
Objective To explore the clinical application value of digital biliary system in minimally invasive surgery for complex gallstone disease. Methods 41 patients with complex cholelithiasis were selected from April 2018 to July 2019. They were randomly divided into an experimental group and a control group. In the experimental group, the hepatobiliary model which established by their CT data was introduced to the digital biliary tract system, and then were applied in preoperative evaluation, surgical simulation, and lithotripsy extraction plan for intraoperative guidance. Minimally invasive surgery was performed on the two groups. Reexamination of stones and recurrence were detected by ultrasound or CT. Results The biliary tract and stones in the experimental group were consistent with those in the digital biliary system. The actual surgical method was consistent with the preoperative simulation and planning. The mean operation time was (160.10 ± 78.82) min, the intraoperative bleeding volume was (2.95±2.28) ml, and the intestinal recovery time was (1.13±0.70) days, all were less than those in the control group. No severe perioperative complications, residual stones and recurrence occurred. In the control group, there were 2 cases of residual stones, 1 case of gastrointestinal bleeding, and 2 cases of recurrence of stones. Conclusions The digital biliary system showed good guiding significance and application value for minimally invasive surgery for complex cholelithiasis. It could decrease the operation time and intraoperative bleeding and shorten intestinal recovery time and would be safe and efficient.
[1] Tazuma S, Unno M, Igarashi Y, et al. Evidence-based clinical practice guidelines for cholelithiasis 2016[J]. J Gastroenterol, 2017, 52(3): 276-300. DOI: 10.1007/s00535-016-1289-7.
[2] 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会. 胆道镜在肝胆管结石病诊断与治疗中的应用专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(7): 611-615. DOI: 10.3760/cma.j.issn.1673-9752.2019.07.001.
[3] 张中文, 蒋兆彦, 韩天权, 等. 胆石病的流行病学和危险因素[J]. 外科理论与实践, 2011, 16(4): 408-412. DOI: CNKI:SUN:WKLL.0.2011-04-023.
[4] European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones[J]. J Hepatol, 2016, 65(1): 146-181. DOI: 10.1016/j.jhep.2016.03.005.
[5] 林钢, 李鹏, 彭国瑞, 等. 数字化结合3D打印技术辅助复杂骨盆骨折的手术设计[J]. 中国临床解剖学杂志, 2016, 34(3): 293-297. DOI: 10.13418/j.issn.1001-165x.2016.03.012.
[6] 郭文彬, 郭晓彬, 张万松, 等. 基于彩色3D打印技术的肾结石个性化手术治疗[J]. 中国临床解剖学杂志, 2018, 36(3): 329-332. DOI: 10.13418/j.issn.1001-165x.2018.03.019.
[7] 郑丽梅, 玉洪荣, 徐晓武, 等. 腹盆腔段输尿管及其周围结构的数字化解剖研究[J]. 中国临床解剖学杂志, 2019, 37(4): 386-389. DOI: 10.13418/j.issn.1001-165x.2019.04.006.
[8] 方驰华, 陈康, 张鹏. 智能化诊疗技术在普通外科中应用现状及前景[J]. 中华外科杂志, 2019, 57(1): 1-5. DOI: 10.3760/cma.j.issn.0529-5815.2019.01.001.
[9] 方驰华, 胡浩宇, 刘允怡, 等. 数字智能化诊疗技术在解剖性肝切除中应用价值[J]. 中国实用外科杂志, 2019, 39(6): 545-551. DOI: CNKI:SUN:ZGWK.0.2019-06-007.
[10] 方兆山， 黄海， 杨剑. 3D和超声引导经皮肝Ⅰ期造瘘联合硬镜治疗复杂肝胆管结石的临床价值[J].中国临床解剖学杂志，2020，38(3):321-326. DOI:10.13418/j.issn.1001-165x.2020.03.015.
[11] 刘景丰, 林科灿. 虚拟肝技术在肝脏外科中的应用[J]. 外科理论与实践, 2010, 15(3): 214-216. DOI: CNKI:SUN:WKLL.0.2010-03-008.
[12] 张庆勇, 周黔川, 赵松. 三维可视化指导不同手术方法联合硬胆道镜治疗复杂性肝胆管结石临床研究[J]. 实用肝脏病杂志, 2018, 21(4): 129-132. DOI: 10.3969/j.issn.1672-5069.2018.04.032.
[13] Lee KF, Fong AKW, Chong CCN，et al. Robotic liver resection for primary hepatolithiasis:Is it beneficial[J]. World J Surg, 2016, 40(10): 2490-2496. DOI: 10.1007/s00268-016-3528-8.
[14] Tejera Hernández AA, Cabrera García ME, Navarro Medina P, et al. Hepatolithiasis. surgical approach using endoscopic holmium laser for treatment[J]. Gastroenterol Hepatol, 2017, 40(1): 16-18. DOI: 10.1016/j.gastrohep.2015.12.003.
[15] 钟世镇. 数字医学在不同学科中的探索应用[J]. 中华整形外科杂志, 2018, 34(6): 406-406. DOI: 10.3760/cma.j.issn.1009-4598.2018.06.000.
[16] 方驰华, 刘允怡, 蔡伟. 数字医学技术在我国普通外科应用的现状和前景[J]. 中华外科杂志, 2017,55(1):11-14. DOI: 10.3760/cma.j.issn.0529-5815.2017.01.004.
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