前列腺尖部区域全息影像三维重构的应用分析

Holographic three-dimensional reconstruction of prostate apex region and its clinical application

目的:探讨前列腺尖部区域全息影像精细建模的可行性和临床价值。方法:回顾性分析2021年1至12月北京大学首钢医院13例行全息影像建模及腹腔镜前列腺根治性切除术患者的临床资料。年龄(71.0±4.7)岁,PSA中位值17.4(6.19,159.6)μg/L。获取患者术前多参数MRI的DICOM数据,在冠、矢、轴三面实时比对下,精细分割、重构前列腺尖部形态及尿道外括约肌复合体。将尖部分为1型尖锐型、2型前唇突出型、3型后唇突出型和4型圆钝型,测量括约肌复合体的总长度和外露长度。尿道外括约肌复合体外露长度≤11.5mm或外露比例≤60%被定义为尿控高风险。尖部存在肿瘤病灶者均定义为尖部瘤控高风险,同时伴有不良尖部形态(1型)或癌灶侵及尖部包膜者定义为极高风险。术前根据尿控及瘤控风险制订个体化尖部处理策略,术中利用全息影像-内镜图像融合系统引导手术实施。结果:13例患者的手术均顺利完成,手术时间(177±43)min,pT分期在T3a~T4者7例。尿道外括约肌复合体总长度为(17.1±3.5)mm,外露长度为(12.2±2.6)mm,外露比例为(72.4±12.8)%。尖部形态为1~4型者分别为2例、2例、4例和5例。术前经全息影像评估为尿控低风险者7例,高风险者6例,术后6个月尿控恢复率分别为6/7(85.7%)和1/6(16.7%),术后12个月尿控恢复率分别为7/7例(100%)和5/6(83.3%)。术前评估尖部瘤控为低风险者3例,高风险者8例,极高风险者2例,术后病理证实的尖部切缘阳性率分别为0/3(0%),3/8(37.5%)和2/2(100%)。结论:全息影像精细重构前列腺尖部区域,有助于预估尿控和瘤控风险,为术中精细操作提供帮助。

Objective:To explore the feasibility and clinical value of holographic modeling of prostate apex region.Methods:The clinical data of 13 patients with holographic modeling and laparoscopic radical prostatectomy in Peking University Shougang Hospital from January to December 2021 were analyzed retrospectively.The age was(71.0±4.7)years old,and the median value of PSA was 17.4(6.19,159.6)μg/L.DICOM data from patients’multi parameter MRI were obtained before operation.The fine morphology of prostate apex and the external urethral sphincter complex were segmented and reconstructed under real-time comparison of coronal,sagittal and axial MRI images.The total length and exposed length of the sphincter complex were measured,and the shape of the prostate apex was divided into type 1 sharp shape,type 2 anterior lip protrusion shape,type 3 posterior lip protrusion shape and type 4 round blunt shape.The exposed length of the external sphincter complex≤11.5mm or the exposed proportion≤60%was defined as the high risk of urinary control.Those with tumor lesions in apex region were defined as high risk of tumor control,and those with type 1 apex or apex capsule invasion were defined as extremely high risk of apex tumor control.The risks of urinary control and apex tumor control were evaluated by holographic images before operation,and personalized apex treatment strategies were formulated.The operations were guided by holographic image-endoscopic image fusion system during operation.Results:All the 13 cases were successfully completed,with an average operation time of(177±43)min,7 patients had pathological stages of T3a-T4.The total length of the sphincter complex revealed by the hologram was(17.1±3.5)mm,the exposed length was(12.2±2.6)mm,and the exposed proportion was(72.4±12.8)%.There were 2 cases,2 cases,4 cases and 5 cases with apex morphology of type 1-4,respectively.A total of 6 patients with high risk of urinary control and 7 patients with low risk of urinary control were evaluated by holographic images before operation.The recovery rates of urinary control in 6 months after operation were 1/6(16.7%)and 6/7 cases(85.7%),respectively,and 5/6(83.3%)and 7/7 cases(100%)in 12months.According to the preoperative evaluation,the tumor control of the apex was low-risk in 3 cases,high-risk in 8 cases and extremely high-risk in 2 cases.The positive rates of the incisional margin of the apex confirmed by pathology were 0/3(0%),3/8(37.5%)and 2/2(100%),respectively.Conclusion:Holographic fine reconstruction of prostate apex region is helpful to predict the risk of urinary control and tumor control,and it is helpful for the individualized treatment of the apex region during surgery.