三维可视化重建技术在机器人辅助巨大嗜铬细胞瘤/副节瘤切除术中的应用价值(附11例报告)

Value of three-dimensional image reconstruction in robotic operation of massive pheochromocytoma and paraganglioma(Report of 11 cases)

目的:探讨三维可视化重建技术在机器人辅助腹腔镜下巨大嗜铬细胞瘤/副节瘤切除术中的应用价值。方法:回顾性分析2019年7月—2020年1月我院收治的11例嗜铬细胞瘤/副节瘤患者的临床资料。其中男5例,女6例,中位年龄44(21~68)岁;肿瘤最大径中位值7.1(6.2~10.2)cm;病变位于右肾上腺3例,左肾上腺5例,右肾门旁腔静脉后方2例,左肾门旁1例。术前所有患者均行CT增强扫描,并采集dicom数据通过VitaWorks重建技术完成三维可视化模型。借助模型,观察肿瘤大小、受累脏器以及术中可能干涉的组织器官和血管,模拟手术路径,指定三维可视化指导的手术方案。结果:利用VitaWorks技术得到了所有肿瘤的精细、完整的三维可视化模型,结合肿瘤大小、部位指定精准手术方案。8例行机器人辅助经腹径路腹腔镜嗜铬细胞瘤切除术;2例行机器人辅助经腹径路腹腔镜副节瘤切除术;1例行机器人辅助经腹腹腔镜左肾上腺嗜铬细胞瘤切除术加左肾切除术。所有手术均顺利完成,无术中转开放。结论:基于CT增强扫描检查的三维可视化重建技术在机器人辅助腹腔镜下巨大嗜铬细胞瘤/副节瘤切除术方面具有应用价值,帮助术者制订精准的个体化手术方案,减少了围手术期间并发症的发生风险,提高了手术的成功率及安全性。

Objective:To discuss the value of three-dimensional image reconstruction in robotic operation of pheochromocytoma/paraganglioma(PHEO/PGL).Methods:From July 2019 to January 2020,the clinical data of 11 patients with PHEO/PGL were retrospectively analyzed.This study included 5 male patients and 6 female patients and the median age was 44 years old(21 to 68 years old).The median value of maximum diameter of tumor was 7.1 cm(ranged 6.2 to 10.2 cm);with 8 cases on adrenal and 3 cases on other retroperitoneal space.All patients underwent four-phase enhanced CT scanning preoperatively.The two-dimensional CT images were collected and reconstructed into a three-dimensional images model through the VitaWorks system.With the help of these 3 D images,the size and location of the tumor,as well as the relationship between tumor and vessels and peripheral organs were observed directly,so that surgeons can locate tumor and plan the operation.Results:After three-dimensional reconstruction,the 3 D image clearly showed the location of tumor and its relationship with surrounding vessels and organs.All patients underwent robot assisted laparoscopic surgery without intra-operative conversion to open surgery.Conclusion:Three-dimensional image construction is valuable for surgery of massive PHEO/PGL and provides an objective basis for decision of surgeon to acquire better perioperative results.