三维可视化技术在腹腔镜胰体尾囊性肿瘤切除中的临床应用

Application of three- dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail

目的探讨三维可视化技术对腹腔镜胰体尾部囊性肿瘤切除的应用价值。方法对2009年12月～2011年3月收治的6例胰体尾部囊性肿瘤患者的临床资料进行回顾性分析。采集全部患者的64排螺旋CT的原始扫描数据集，通过自适应区域生长算法对CT序列图像进行图像程序分割和自动提取，再采用方驰华教授研发的图像处理软件对图像数据进行三维重建，根据重建的图形制定具体的手术入路（trocar位置）、手术方式等。结果三维重建后的胰体尾部肿瘤与邻近脏器的三维结构清楚，特别是肿瘤与脾动静脉以及脾门的关系明晰。所有患者均行腹腔镜下胰体尾切除，无围手术期死亡；在保脾方面，除1例因为是黏液性囊腺癌而行胰体尾＋脾切除外，其余5例均保留脾脏，保脾率为83．3％（5／6）；术后并发症方面，胰瘘发生率33．3％（2／6），无手术后出血。平均住院天数12d。结论腹腔镜下胰体尾切除具有手术创伤小，术后恢复陕、保脾率高等优点；胰腺CT数据三维重建对腹腔镜下胰体尾肿瘤切除的个体化手术方案制定有很大的应用价值。

Objective To study the application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail. Methods Six cases of cystic carcinoma in the pancreatic body and tail treated between Nov, 2009 and Mar, 2011 were retrospectively analyzed. The original image data of 64-slice spiral CT were collected and using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted to obtain the 3-dimensional reconstruction images with customized image manipulation software. The specific surgical approach （the trocar position） and surgical procedure were planned based on the reconstructed mode. Results The reconstructed 3-dimensional model clearly displayed cystic carcinoma in the pancreatic body and tail and the adjacent organs, showing distinct relationship between the cystoma and the splenic artery and vein. All the patients successfully underwent laparoscopic resection of the pancreatic body and tail without perioperative death. The spleen was preserved in 5 cases and removed in 1 case due to mucinous cystadenocarcinoma. The overall rate of pancreatic fistulae was 33.3% hemorrhage. The average hospital stay of the patients was 12 days. Conclusion without incidences of postoperative reconstruction based on pancreatic CT data provides valuable assistance for laparoscopic resection of cystic carcinoma in the pancreatic body and tail .