全息多模态实时三维导航技术在肺部病变外科定位中的临床价值

Clinical value of holographic multimodal real-time three-dimensional navigation technology in the surgical location of pulmonary lesions

目的:探索利用全息多模态实时化三维导航(3D-HMRN)技术对肺部微小病变进行导航定位的临床价值。方法:回顾性收集2017年6月至2019年12月在解放军总医院第一医学中心胸外科住院行肺部小结节外科局部切除的152例患者资料,按照随机数字法分为2组:试验组76例,男31例,女45例,年龄(47±17)岁,术前进行侧卧位导航模式CT扫描并行手术区域三维重建,手术开始前采用全息多模态实时三维导航技术引导进行病变定位穿刺,操作完成后采用术中CT对穿刺位置进行验证,确定穿刺的准确性和误差范围;对照组76例,男34例,女42例,年龄(50±19)岁,直接进行术中CT定位。最后对两组定位数据进行对比和统计学分析。结果:试验组76例病例,首次成功率97.4%,误差(3.9±0.9)mm,操作时间(4.4±1.2)min;对照组术中CT定位一次成功率98.7%,误差(3.5±1.0)mm,操作时间(10.7±2.6)min;两组穿刺定位成功率和定位精度比较差异均无统计学意义(均P>0.05),但试验组操作时间明显缩短(P<0.01)。结论:全息多模态实时三维导航技术操作省时,定位准确,可以作为肺部微小结节外科治疗术中定位的有效方法。

Objective To investigate the clinical value of holographic multimodal real-time three-dimensional navigation(3D-HMRN)technology for navigation and localization of pulmonary micro lesions.Methods A total of 152 patients who underwent thoracoscopic partial resection of small pulmonary nodules in the Department of Thoracic Surgery of the First Medical Center of Chinese PLA General Hospital from June 2017 to December 2019 were retrospectively collected and were divided into two groups by computer random number.The experimental group consists of 76 patients(31 males and 45 females)with a mean age of(47±17)years.CT scan in lateral position navigation mode and 3D reconstruction of the surgical area were performed on all patients.Before the operation,holographic multimodal real-time 3D navigation technology was used to guide the puncture of the lesion.After the operation was completed,the intraoperative CT was used to verify the location of the puncture and determine the accuracy and error rang of the puncture.The control group consists of 76 patients(34 males and 42 females)with a mean age of(50±19)years.Intraoperative CT positioning was directly subjected to the patients.And then,the localization data of the two groups were compared and statistically analyzed.Results Seventy-six cases of positioning puncture using navigation technology,the first success rate was 97.4%,the error was(3.9±0.9)mm,and the average operation time was(4.4±1.2)min;while the success rate of one-time CT positioning during routine surgery was 98.7%,the error was(3.5±1.0)mm,and the average operating time was(10.7±2.6)min.Compared with intraoperative CT positioning,the success rate and positioning accuracy of 3D-HMRN were not statistically significant(both P>0.05),however the operation time was significantly shortened(P<0.01).Conclusion The holographic multi-modal real-time 3D navigation technology saves time and has accurate positioning,which may be used as an effective method for localization of pulmonary micro nodules during surgical treatment.