基于CT dicom数据3D全息可视化成像在肾及腹膜后巨大肿瘤精准手术的应用

3D holographic visualization imaging based on CT dicom data for huge renal and retroperitoneal neoplasm precision surgery

目的探讨基于CT dicom数据3D全息可视化成像在肾及腹膜后巨大肿瘤精准手术中的应用。方法选取2018年4~11月北京协和医院收治的7例患者,术前诊断肾肿瘤4例,腹膜后肿瘤3例。肿瘤截面最小直径4.0~12.0 cm(平均8.2 cm),肿瘤截面最大直径8.2~27.0 cm(平均12.7 cm)。瘤体体积106~4 186 ml,平均896 ml。采集患者CT增强扫描检查的dicom数据,用三维可视化软件(VITA works 3D)进行融合立体全息成像重建,包括肿瘤、受累器官、腹主动脉下腔静脉腹段,以及手术可能涉及的肝、胆、胰、脾和淋巴结等,据此制订三维可视化指导的手术方案。结果 7例患者术前均完成基于CT增强扫描检查的dicom数据3D全息可视化成像,结合肿瘤大小、部位制订精准手术方案。1例行后腹腔镜肾癌根治术加腹膜后淋巴结清扫术;1例先行后腹腔镜处理肾动脉,然后经腹开放根治性肾切除术;2例经腹开放根治性肾切除术;2例后腹腔镜腹膜后肿瘤切除术;1例经腹开放保留肾单位肾肿瘤切除术。结论基于CT增强扫描检查的dicom数据3D全息可视化成像可向术者呈现肿瘤、血管、毗邻脏器的立体结构关系,从而制订与实施精准、安全、创伤最小的手术方案。

Objective To evaluate the use of 3 D holographic visualization imaging(3 D HVI) based on CT dicom data for huge renal and retroperitoneal neoplasm and guide the undergoing of precision surgery for these patients. Methods From April to November 2018, seven patients were enrolled, four were diagnosed with renal tumor and three were diagnosed with retroperitoneal neoplasm. The dimeters for minimum intersecting surface of the lesions were 4.0-12.0 cm and maximum were8.2-27.0 cm. 3 D HVI based on CT dicom data for these patients was used to reconstructed the tumors, invasive and adjacent organs, targeted and aberrant vessels. The surgery procedure was made according to these reconstructed imaging. Results All of the patients finished the 3 D HVI based on CT dicom data, a precise operation was formulated for each case. One case underwent retroperitoneal laparoscopic radical nephrectomy plus retroperitoneal lymphadenectomy, one case underwent retroperitoneal laparoscopic renal artery treatment followed by open radical nephrectomy, two cases underwent open radical nephrectomy, two cases underwent retroperitoneal laparoscopic retroperitoneal tumor resection, and one case underwent open nephronsparing nephrectomy. Conclusions Volume rendering 3 D reconstruction imaging based on CT dicom data can give a holographic visualized showing which present the tumor, aberrant vessel, and involved organs clearly. And by using this technic,the patients could undergo an operation precisely and safely.