三维可视化技术在原发性腹膜后脂肪肉瘤切除术中的应用

Application of three-dimensional visualization technology in the resection of primary retroperitoneal liposarcoma

目的探讨三维可视化技术在原发性腹膜后脂肪肉瘤（PRPLS）切除术中的应用价值。方法回顾性分析2014年7月厦门大学附属成功医院肝胆胰血管外科收治的1例64岁PRPLS男性患者的临床资料，应用三维可视化技术将患者术前腹部cT图像进行三维重建，通过观察肿瘤与腹腔器官、腹部大血管之间的关系及测量肿瘤体积、手术模拟进行术前评估。术前手术方案拟采用分步减瘤逐步完全切除肿瘤的方法。术中沿着脂肪肉瘤的包膜分离粘连，精细操作，依次将肿瘤从右肾、下腔静脉、肝脏剥离，最终通过分步减瘤的方法将肿瘤完全切除。术后对患者行cT检查随访。随访时间截至2014年9月。结果三维可视化重建后图像清晰立体地显示肿瘤组织、腹腔实质器官、腹腔大血管的解剖结构及毗邻关系，术中证实三维重建肿瘤的解剖关系与实际基本一致。患者手术时间为5．5h，术中出血量为1500mL，切除的肿瘤质量为7．512kg。患者术后2周痊愈出院，术后2个月复查cT未见肿瘤复发。结论三维可视化技术在PRPLS切除术前可行精确评估及手术方案的制订，减少术中的盲目性，使患者获得良好的手术疗效。

Objective To explore the value of three-dimensional visualization technology in the resection of primary retroperitoneal liposarcoma（PRPLS）. Methods The clinical data of a male patient aged 64 years with PRPLS who was admitted to the Chenggong Hospital in July 2014 were retrospectively analyzed, The preoperative abdominal images of computed tomography （CT） were converted to the three-dimensional images by three-dimen- sional visualization technology, The patient underwent a full preoperative assessment by observing the relationship of tumor and abdominal viscera as well as major abdominal vessels and measuring the volume of tumor and surgery simulation. The tumor was completely resected according to the preoperative surgical plan. During the operation, adhesion was separated along liposarcoma coating and the tumor was stripped out from the fight kidney, inferior vena cava and liver. The patient was followed up by CT examination after surgery till September 2014. Results The three-dimensional reconstruction of the CT data of the patient clearly displayed the anatomical structure and adjacent relationship between the tumor, abdominal organs and major abdominal vessels. The preoperative evalua- tion of the anatomy of the tumor based on three-dimensional images was confirmed with operative findings. The operation time was 5.5 hours, the volume of intraoperative blood loss was 1 500 mL and the weight of resected tumor was 7. 512 kg. The patient was discharged at postoperative week 2. No tumor recurrence was detected by CT examination at postoperative month 2. Conclusion The three-dimensional visualization technology will be a feasi- ble method to exactly evaluate and develop surgery plan and reduce the blindness of operation, meanwhile, it can provide significant clinical efficacy for patients.