渐进性人工气腹前后基于3D精准容积重建术前“透视”腹壁疝

Preoperative "fluoroscopy" abdominal wall hernia based on 3D precise volume reconstruction before and after progressive prosthetic pneumoperitoneum

目的:探讨腹部CT容积测量及重建技术在指导腹壁疝患者行术前渐进性人工气腹(PPP)治疗中的价值。方法:选取2016年3月—2018年6月于本院确诊腹壁疝并进行PPP后行腹部CT检查的47例患者进行回顾性研究分析,通过Vitrea 3D后处理勾画容积测量PPP前后两次CT检查所得疝囊容积(VIH)、腹腔容积(VAC)、腹腔总容积(VP=VIH+VAC),并计算疝囊/腹腔体积比(VIH/VP);并分析疝囊内容物PPP前后的变化;随访其治疗效果。结果:47例患者术后住院平均10.6±8.9天,术后切口愈合不良2例,脑梗塞1例,心率失常1例,补片感染1例。所有患者均顺利完成了手术,术后无一例发生腹腔高压相关并发症。PPP前后VAC分别为6092.95±1424.95ml、8444.91±1882.15ml,差异具有统计学意义(P<0.05)。结论:腹部CT容积测量及三维重建在腹壁疝的外科治疗中能提供有效的辅助作用,可以准确提供疝囊与腹腔体积的计算依据,为疝修补术前PPP治疗和手术治疗腹壁疝提供客观依据。

Objective To investigate the application value of multislice spiral CT abdominal cavity volume measurement techniques in preoperative progressive pneumoperitoneum(PPP)before hernia repair.Methods A retrospective study was performed on 47 patients who underwent abdominal CT scans and underwent PPP in our hospital from March 2016 to June 2018.The volume of hernia sac(VIH),abdominal cavity and(volume of the hernia sac/total volume of the abdominal cavity)×100.0%were respectively calculated by software Vitrea 6.3.The changes of hernia volumes before and after PPP were analyzed and the treatment effect was followed up.Results 47 patients were hospitalized for an average of 10.6±8.9 days,with a median of 8 days.There were 2 cases of poor wound healing,1 case of secondary cerebral infarction,1 case of heart rate disorder and 1 case of patch infection.All patients successfully completed the operation,no postoperative complications associated with abdominal hypertension.Volumes of the abdominal cavity before and after PPP were(6092.95±1424.95)ml and(8444.91±1882.15)ml,with a statistically significant difference(P<0.05).Conclusions The multislice spiral CT abdominal cavity volume measurement techniques can provide an effective assistant role in the surgical treatment of abdominal wall hernia,and can provide accurate basis for calculating the volume of hernia sac and abdominal cavity,and provide objective basis for PPP treatment and operation before hernia repair.