三维可视化重建技术在机器人辅助肾部分切除术中的应用

Application of three-dimensional visualization reconstruction technology in robot-assisted partial nephrectomy

目的:探讨三维可视化重建技术在机器人辅助肾部分切除术中的应用价值。方法:回顾分析2016年8月~2019年10月天津医科大学肿瘤医院145例行机器人辅助肾部分切除术患者的临床资料,分为三维重建组(n=77)和传统影像组(n=68)。对两组患者的一般资料进行倾向评分匹配,比较两组患者的手术时间、热缺血时间、术后住院时间、术后拔管时间、术后并发症等临床指标,评价并分析三维可视化重建在机器人辅助肾部分切除术中的应用价值。结果:145例患者均顺利完成手术,未出现严重术中并发症和围手术期死亡。倾向评分匹配分析显示,三维重建组手术时间显著短于传统影像组[(133.92±30.76)min Vs(157.70±36.13)min,P<0.05]、术后住院时间显著短于传统影像组[(6.94±1.41)d Vs(8.24±3.32)d,P<0.05]。两组患者术中出血量、热缺血时间、术后拔管时间、术后24h内肌酐上升值和血红蛋白下降值比较,差异均无统计学意义(均P>0.05)。结论:术前完善三维可视化重建有助于行手术前规划,可提高复杂肾部分切除手术成功率,缩短机器人辅助肾部分切除术的手术时间和术后住院时间。

Objective:To explore the application value of three-dimensional visualization reconstruction technology in robot-assisted partial nephrectomy.Methods:The clinical data of 145 patients with renal carcinoma underwent robot-assisted partial nephrectomy from August 2016 to October 2018 in Tianjin Medical University Cancer Hospital were reviewed.145 patients were divided into three-dimensional reconstruction group(n=77)and traditional image group(n=68).Propensity score matching(PSM)was applied to reduce the effects of observed confounding between the two groups.The operation time,warm ischemia time,postoperative hospital stay,drainage tube removal time and complications between the two groups were compared.The appication value of three-dimensional visualization reconstruction technology in robot-assisted partial nephrectomy was evaluated.Results:All the 145 cases were successfully completed without intraoperative complications and perioperative death.Propensity score matching analysis showed that the operation time of three-dimensional reconstruction group was significantly shorter than the traditional image group[(133.92±30.76)min Vs(157.70±36.13)min,P<0.05]and the postoperative hospital stay was significantly less than the traditional image group[(6.94±1.41)d Vs(8.24±3.32)d,P<0.05].There were no significant differences between the two groups on the intraoperative blood loss,warm ischemia time,drainage tube removal time,the increasing of creatinine and decreasing of hemoglobin within 24 hours after operation(P>0.05).Conclusion:Preoperative three-dimensional visualization reconstruction is conducive to perform preoperative planning and improve the success rate of surgery for complex partial nephrectomy.Meanwhile,it can shorten the operation time and postoperative hospitacization of robot-assisted partial nephrectomy.