三维重建虚拟手术规划技术在零缺血腹腔镜肾部分切除术治疗cT1b期肾肿瘤中的应用

Clinical application of three-dimensional reconstruction virtual surgical planning technology in zero ischemia laparoscopic partial nephrectomy in the treatment of cT1b renal tumors

目的:探讨三维重建虚拟手术规划技术在零缺血腹腔镜肾部分切除术治疗cT1b期肾肿瘤中的临床应用价值。方法:回顾性分析2018年1月至12月间在上海交通大学医学院附属仁济医院泌尿外科行零缺血腹腔镜肾部分切除术的55例cT1b期肾肿瘤病例,其中三维重建组患者29例,CTA组患者26例。三维重建组患者术前行增强CT并在虚拟手术规划技术平台进行三维重建,并根据重建结果确定肿瘤位置、肿瘤供应血管位置、周围血管分布情况,从而制定手术方案,术中根据术前制定方案行零缺血腹腔镜肾部分切除术。CTA组患者术前常规行肾脏增强CT,并根据增强CT影像行零缺血腹腔镜肾部分切除术。比较三维重建组与CTA组间术中出血量、手术时间、术中及术后并发症情况。结果:本研究55例患者均顺利完成手术,无中转开放或根治手术,无严重并发症发生。两组患者年龄、性别、BMI、肿瘤直径、R.E.N.A.L评分差异无统计学意义(P>0.05)。三维重建组相比CTA组手术时间更短、术中出血量更少,差异具有统计学意义(P<0.05)。所有患者术后病理切缘均为阴性。结论:三维重建虚拟手术规划技术通过术前可视化评估肿瘤、肾脏、血管解剖结构及相对位置,可帮助术者术前合理规划手术方式,在腹腔镜零缺血肾部分切除术中可以有效缩短手术时间,减少术中出血量,具有一定的临床应用价值。

Objective:To investigate the clinical application value of three-dimensional reconstruction virtual surgical planning technology in zero ischemia laparoscopic partial nephrectomy for cT1b stage renal tumors.Methods:The clinical data of 55 patients with cT1b renal tumor who underwent zero-ischemia laparoscopic partial nephrectomy between January to December 2018 were retrospectively analyzed,including 29 patients in the 3D reconstruction group and 26 patients in the CTA group.Patients in the 3D reconstruction group underwent preoperative enhanced CT and 3D reconstruction on the virtual surgical planning technology platform.Tumor location,tumor supply blood vessel location,and surrounding blood vessel distribution were determined according to the reconstruction results,so as to formulate the surgical plan.Laparoscopic partial nephrectomy under zero ischemia circumstance was performed.Patients in the CTA group underwent routine renal enhanced CT before surgery,and underwent zero ischemia laparoscopic partial nephrectomy according to the enhanced CT images.The intraoperative blood loss,operation time,intraoperative and postoperative complications were compared between the three-dimensional reconstruction group and the CTA group.Results:All patients successfully completed the operation without conversion to open surgery or radical nephrectomy,and no serious perioperative complications occurred.There were no significant differences in age,gender distribution,body mass index,tumor diameter and R.E.N.A.L.scores between the two groups(P>0.05).The 3D reconstruction group had shorter operation time and less intraoperative blood loss than the CTA group(all P<0.05).Conclusion:The 3D reconstruction virtual surgical planning technology can evaluate the anatomical structure and relative positions of tumor,kidney and blood vessels through preoperative visualization,which can help to plan the surgical method reasonably before surgery.