混合现实技术对腹腔镜下肿瘤动脉阻断肾部分切除手术的指导价值

Guiding value of mixed reality technology in laparoscopic partial nephrectomy with tumor artery occlusion

目的:探讨混合现实技术在腹腔镜下选择性肿瘤动脉阻断肾部分切除手术的指导价值和经验。方法:回顾性分析2018年1月—2019年8月在我院泌尿外科就诊并行肾部分切除术的肿瘤患者共30例。其中混合现实技术指导下肿瘤动脉阻断肾部分切除术15例(实验组),其中男8例,女7例;左侧7例,右侧8例;临床肿瘤分期T1a~T1bN0M0,术前肌酐(76.21±8.34)μmol/L,术前行CTA、CTU检查后,将CT影像原始数据,导入专用软件系统(Materialise Mimics系统+MR 3D系统),建立全息3D影像模型;术中用全息3D影像模型,与手术过程中显示屏图像实时融合。未辅助混合现实技术肿瘤动脉阻断肾部分切除术15例(对照组),其中男9例,女6例,左侧9例,右侧6例;临床肿瘤分期T1a~T1bN0M0,术前肌酐(77.51±8.10)μmol/L。结果:所有手术均成功腹腔镜下完成,无严重手术并发症。实验组,在混合现实技术指导下,所有肿瘤动脉(肾段动脉或更下级分支动脉)均得到清晰暴露并阻断,均未行肾动脉主干阻断,阻断时间(24.80±2.54)min,寻找肿瘤动脉时间(10.80±1.90)min,手术时间(104.20±5.66)min,手术失血量(81.73±5.85)mL,术后住院天数(6.33±1.23)d,术后肌酐(78.19±6.89)μmol/L。对照组,肿瘤动脉阻断时间(26.73±3.13)min,寻找肿瘤动脉时间(23.47±3.46)min,手术时间(134.60±8.70)min,手术失血量(93.40±8.91)mL,术后住院天数(7.00±1.20)d,术后肌酐(81.64±7.14)μmol/L。结论:混合现实技术可提高选择性肿瘤动脉阻断肾部分切除术的成功率并降低手术风险,使手术朝更精准化方向发展。

Objective:To explore the guiding value and experience of mixed reality technology in laparoscopic nephron sparing surgery for renal tumors by tumor artery occlusion.Methods:A retrospective analysis was made on 30 tumor patients who underwent partial nephrectomy from January 2018 to August 2019.Among them,15 cases(experimental group)underwent partial nephrectomy with tumor artery occlusion under the guidance of mixed reality technology,including 8 males,7 females,7 left and 8 right side.Their clinical tumor stage was T1 a—T1 bN0M0,and preoperative creatinine was(76.21±8.34)μmol/L.After CTA and CTU examination before operation,the original CT image data were imported into a special software system(Materialise Mimics system+MR 3 D system)to establish a holographic 3 D image model.The holographic 3 D image model was used in the operation,which was fused with the screen image in real time.Other 15 cases(control group)underwent partial nephrectomy without assistance of mixed reality technique,including 9 males,6 females,9 left and 6 right side.Their clinical tumor stage was T1 a—T1 bN0M0,and preoperative creatinine was(77.51±8.10)μmol/L.Results:All the operations were successfully performed under laparoscopy without serious complications.In the experimental group,under the guidance of mixed reality technology,all tumor arteries(segmental or inferior branches of renal artery)were clearly exposed and blocked,but renal artery trunk was not blocked.The blocking time was(24.80±2.54)min,and the searching time was(10.80±1.90)min.The operation time was(104.20±5.66)min,and the blood loss was(81.73±5.85)ml.The postoperative hospital stay was(6.33±1.23)days,and postoperative creatinine was(78.19±6.89)μmol/L.In the control group,the time to block tumor artery was(26.73±3.13)min,and the time to find tumor artery was(23.47±3.46)min.The operation time was(134.60±8.70)min,and the blood loss was(93.40±8.91)ml.The hospital stay was(7.00±1.20)d,and the creatinine was(81.64±7.14)μmol/L.Conclusion:Mixed reality technology can improve the success rate and reduce the risk of selective tumor artery occlusion in partial nephrectomy.