3D与2D腹腔镜结直肠癌根治术中术者主观感受的随机对照研究

Subjective perception of surgeons with three-dimensional and two-dimensional systems in laparoscopiccolorectal surgery： a randomized controlled trial

目的比较3D与2D腹腔镜结直肠癌根治术中手术医师的主观感受。方法采用前瞻性研究方法。选取2013年11月至2015年6月上海交通大学医学院附属瑞金医院行3D与2D腹腔镜结直肠癌根治术的主刀医师、第一助手和扶镜手在术后2h内完成针对手术医师的主观问卷调查表。将手术医师分为3D腹腔镜组和2D腹腔镜组，3D腹腔镜组手术医师采用3D腹腔镜及4方向镜行腹腔镜结直肠癌根治术；2D腹腔镜组手术医师采用2D腹腔镜及可转换30。镜行腹腔镜结直肠癌根治术。主观感受调查问卷内容包括连续运动视觉差，双眼聚焦差异度，2D或3D像素稳定度，视野、视角操控协调度，视觉自由度，3D无效区，影像生成力，不同分辨率下调控光线发射能力，画面快速更新率，光亮度，分辨率，纵深感，颜色分辨率。观察指标：（1）总体比较3D与2D腹腔镜组手术医师对腹腔镜的主观感受评分。（2）分别比较3D与2D腹腔镜组主刀医师、第一助手及扶镜手对腹腔镜的主观感受评分。正态分布的计量资料以元±s表示，比较采用￡检验。结果筛选出有效问卷调查表85份，其中3D腹腔镜组为53份（主刀医师、第一助手和扶镜手分别为16、21、16份），2D腹腔镜组32份（主刀医师、第一助手和扶镜手分别为10、12、10份）。（1）两组手术医师对腹腔镜的主观感受评分总体比较：3D腹腔镜组手术医师双眼疲劳度，双眼聚焦差异度，视野、视角操控协调度，纵深感评分分别为（4．3±0．8）分，（4．5±0．7）分、（4．2±0．8）分、（4．4±0．7）分，2D腹腔镜组分别为（4．6±0．5）分、（4．9±0．7）分、（4．7±O．6）分、（3．9±0．8）分，两组比较，差异均有统计学意义（￡=1．899，3．493，2．458，-2．872，P〈0．05）。（2）两组主刀医师对腹腔镜的主观感受评分比较：3D腹腔镜组主刀医师双眼聚焦差异度，视野、视角操控协调度，颜色分辨率评分分别为（4．4±0．7）分、（3．9±0．8）分、（4．6±O．6）分，2D腹腔镜组分别为（5．0±0．0）分、（4．6±0．7）分、（5．0±0．0）分，两组比较，差异均有统计学意义（t=2．426，2．423，1．901，P〈0．05）。（3）两组第一助手对腹腔镜的主观感受评分比较：3D腹腔镜组第一助手双眼聚焦差异度、空间定向感、纵深感评分分别为（4．4±O．7）分、（4．7±0．6）分、（4．4±0．7）分，2D腹腔镜组分别为（4．8±0．4）分、（4．1±0．4）分、（3．8±1．1）分，两组比较，差异均有统计学意义（t=1．740，-2．062，-1．868，P〈O．05）。（4）两组扶镜手对腹腔镜的主观感受评分比较：3D腹腔镜组扶镜手双眼聚焦差异度，视野、视角操控协调度评分分别为（4．6±0．6）分、（4．4±0．7）分，2D腹腔镜组分别为（5．0±0．0）分、（4．9±0．3）分，两组比较，差异均有统计学意义（t=1．901，1．891，P〈0．05）。结论结直肠癌根治术中3D腹腔镜其手术操作与2D腹腔镜相似，虽在双眼疲劳度、眩晕感方面较2D腹腔镜欠佳，但可提供良好的三维视野，加强手术立体感、纵深感，协助辨认解剖结构、层次等优势。

colorectal surgery with 3D laparoscope and 4-directional camera were allocated into the 3D laparoscopic group and surgeons who performed laparoscopic colorectal surgery with 2D laparoscope and 30° convertible camera were alh）cated into the 2D laparoscopic group. The questionnaire included visual difference of continuous motion, binocular focusing difference, 2D or 3D pixel stability, control coordination of visual angle, freedom of view angle, inactive area of 3D, imaging capacity, light control capacity, frame rate, radiance, resolution ratio, depth description and eolour resolution. Observation indicators included： （ 1 ） overall comparison of the subjective scores for laparoscope between surgeons of 3D and 2D laparoscopic groups. （2） Respective comparison of the subjective scores for laparoscope between major surgoens, first assistants, camera assistants of 3D and 2D laparoscopic groups. Measurement data with normal distribution were presented as x ± s, and comparison was done by the t test. Results All the 85 questionnaires were screened for eligibility, including 53 in the 3D laparoscopie group （ 16 from major surgoens, 21 from first assistants, 16 from camera assistants） and 32 in the 2D laparoscopic group （ 10 from major surgoens, 12 from first assistants, 10 from camera assistants）. （ 1 ） Overall comparison of the subjective scores for laparoscope between surgeons of 3D and 2D laparoscopic groups： the scores of surgeons for ophthahnic /htigue degree, ophthalmic vertigo degree, control coordination degree of visual angle and depth description were 4. 3 ±0. 8,4. 5 ±0. 7, 4. 2 ±0. 8,4. 4 ±0. 7 in the 3D laparoscopic group and4. 6 ±0. 5, 4. 9 ± 0. 7, 4. 7 ± 0.6, 3.9 ± 0. 8 in the 2D laparoscopic group, respectively, with statistically significant differences （t = 1. 899, 3. 493, 2. 458, - 2. 872, P 〈 0. 05 ）. （2） Comparison of the subjective scores for laparoscope between major surgeons of 3D and 2D laparoscopic groups： the scores of major surgeons for ophthahnic vertigo degree, control coordination degree of visual angle and eolour resolution were 4. 4 ± 0. 7, 3.9 ± 0. 8, 4. 6 ± 0. 6 in the 3D lapamscopic group and 5.0 ± 0. 0, 4. 6 ±0. 7, 5.0 ±0. 0 in the 2D laparoseopic group, respectively, with statistically significant differences （ t = 2. 426, 2, 423, 1. 901, P 〈 0. 05 ）. （3） Comparison of the subjective scores [＇or laparoscope between first assistants of 3D and 2D laparoseopie groups： the scores of first assistants for ophthalmic vertigo degree, topographical orientation and depth description were 4. 4 ± 0. 7, 4. 7± 0. 6, 4. 4 ± 0. 7 in the 3D laparoscopie group and 4. 8 ± 0.4, 4. 1 ± 0. 4, 3.8 ± 1.1 in the 2D laparoseopic group, respectively, with statistically significant differences （ t = 1. 740, - 2. 062, - 1. 868, P 〈 0. 05 ）. （4） Comparison of the subjective scores for laparoseope between camera assistants of 3D and 2D laparoseopic groups ： the scores of camera assistants tot ophthalmic vertigo degree and control coordination degree of visual angle were 4. 6 ± 0. 6, 4.4 ± 0. 7 in the 3D laparoseopie group and 5.0 ± 0. 0, 4. 9 ± 0. 3 in the 2D laparoscopic group, respectively, with statistically significant differences （ t = 1. 901, 1. 891, P 〈 0. 05 ）. Conclusions 3D laparoseopic system is similar to the traditonal 2D laparoscopie system in surgical procedures of laparoseopic eolorectal surgery. Compared with 2D laparoscopie system, 3D laparoscopie system is not good enough in the ophthalmic fatigue degree and the degree of ophthalmic vertigo, however, it can provide good three-dimensional vision, strengthen stereoscopic vision and deptb, help identify anatomical structure and level.