基于3D Slicer软件的蝶鞍区三维重建技术在经蝶内镜垂体瘤切除术中的应用价值

The value of 3D sellar region reconstruction based on 3D Slicer software in endoscopic transsphenoidal surgery for pituitary adenoma

目的:探讨基于3D Slicer软件的蝶鞍区三维重建对经蝶内镜垂体瘤切除术的指导作用。方法:将2017年10月至2019年3月徐州医科大学附属医院神经外科收治的70例垂体瘤病人随机分为两组:术前重建组和传统手术组。术前重建组术前使用图像处理软件3D Slicer对影像学数据进行蝶鞍区骨性标志、垂体瘤瘤体及颈内动脉、视神经结构的三维重建,并进行术前规划。将三维重建所显示的鞍区解剖标志与术中内镜下所见术野图像进行对比分析,评价三维重建图像与术野图像的吻合度。传统手术组不进行三维重建,按常规流程实施手术。比较术前重建组与传统手术组在手术时间、术中出血量、术后住院时间及术后并发症发生率方面的差异。结果:三维重建与术中内镜对上鼻甲、中鼻甲、鼻中隔完全显示率均为100%。三维重建对于蝶窦开口、视神经管隆起、颈内动脉隆起、颈内动脉-视神经隐窝的完全显示率分别为100%、88%、94%、94%,均显著高于术中内镜所见(P<0.05)。术前重建组在手术时间、术中出血量、术后住院时间、术中脑脊液漏发生率方面优于传统手术组(P<0.05),而视神经损伤、颈内动脉损伤、术后脑脊液漏发生率、术后尿崩的发生率上,两组没有明显差异(P>0.05)。结论:基于3D Slicer的三维重建技术对鞍底解剖标志的显示具有较高的还原性和准确度,有助于提前预判手术场景,开展手术教学。同时对于未配备术中导航的医疗机构,可以一定程度上提高手术精确度和安全性,降低并发症发生率。

Objective:To investigate the application value of 3D reconstruction technique based on 3D Slicer software in endoscopic transsphenoidal surgery for pituitary adenoma.Methods:From October 2017 to March 2019,70 patients with pituitary adenoma treated in department of neurosurgery,Affiliated Hospital of Xuzhou Medical University,were randomly divided into two groups:Preoperative reconstruction group and traditional surgical group.In the preoperative reconstruction group,the image processing software 3D Slicer was used to reconstruct the bone markers of sellar region,pituitary tumor,internal carotid artery and optic nerve structure before operation,and the preoperative planning was carried out.In order to evaluate the degree of reduction of 3D reconstructed images,the anatomical signs of sellar region displayed by 3D reconstruction were compared with the operative field images under endoscopy.The traditional surgical group did not perform three-dimensional reconstruction and performed the operation according to the routine procedure.The operative time,intraoperative bleeding volume,postoperative hospital stay and incidence of postoperative complications of reconstruction group were compared with those of traditional surgical group.Results:The complete display rates of superior turbinate,middle turbinate and nasal septum were 100%by 3D reconstruction and endoscopy.The complete display rates of 3D reconstruction for sphenoid sinus ostium,optic protuberance,carotid protuberance and optico-carotid recess were 100%,88%,94%and 94%,respectively,which were significantly higher than those of endoscopy(P<0.05).The operative time,intraoperative bleeding volume,postoperative hospitalization time and the incidence of intraoperative cerebrospinal fluid leakage in the reconstruction group were better than those in the traditional surgical group(P<0.05),however,there was no significant difference between the two groups in the incidence of optic nerve injury,internal carotid artery injury,postoperative cerebrospinal fluid leakage and postoperative urinary avalanche(P>0.05).Conclusion:The 3D reconstruction technology based on 3D Slicer has high reducibility and accuracy in the display of saddle floor anatomical marks,which is helpful to predict the surgical scene in advance and carry out surgical teaching.At the same time,for medical institutions without intraoperative navigation,the accuracy and safety of operation can be improved to a certain extent,and the incidence of complications can be reduced.