Dong Chang-Cheng, Fang Chi-Hua, Wu Tian-Chong, Cai Wei, Fan Ying-Fang, Yang Jian, Zeng Ning, Zhong Shi-Zhen, Bao Su-Su
Hepatogastroenterology. 2014 Sep;61(134):1556-62.
Treatment of complicated hepatolithiasis is complex and difficult. In this report, we present a novel approach to manage complicated hepatolithiasis using the rigid choledochoscope guided by CT-based 3D reconstruction technique with or without hepatectomy.
Between February 2012 to December 2013, 25 patients with complicated hepatolithiasis underwent rigid choledochoscope guided by CT-based 3D reconstruction technique combined with or without hepatectomy. 27 patients with complicated hepatolithiasis underwent a traditional operation (traditional method group) from June 2011 to January 2012. All operations were performed by the authors.
The final stone clearance rate of the rigid choledochoscope group was 96%, whereas that of the traditional method group was 74.1% (P=0.032). There was no patient died of postoperative mortality in two groups. Moreover, the operative time in the traditional method group was significantly longer than that in the rigid choledochoscope group (P=0.010). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups.
Operative rigid choledochoscope guided by CT-based 3D reconstruction technique combined with or without hepatectomy may be an effective and safe treatment for complicated hepatolithiasis.
复杂肝内胆管结石的治疗复杂且困难。在本报告中，我们介绍一种使用基于CT三维重建技术引导的硬性胆道镜结合或不结合肝切除术来处理复杂肝内胆管结石的新方法。
2012年2月至2013年12月期间，25例复杂肝内胆管结石患者接受了基于CT三维重建技术引导的硬性胆道镜检查，结合或不结合肝切除术。2011年6月至2012年1月期间，27例复杂肝内胆管结石患者接受了传统手术（传统方法组）。所有手术均由作者完成。
硬性胆道镜组的最终结石清除率为96%，而传统方法组为74.1%（P = 0.032）。两组均无患者死于术后死亡。此外，传统方法组的手术时间明显长于硬性胆道镜组（P = 0.010）。两组随访期间均未发现复发性肝内胆管结石。
基于CT三维重建技术引导的硬性胆道镜结合或不结合肝切除术可能是治疗复杂肝内胆管结石的一种有效且安全的方法。
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