3D可视化技术辅助腹腔镜下巨大肾上腺肿瘤切除术的临床研究

Clinical research of 3D visualization technology assisted laparoscopic resection of giant adrenal tumors

目的分析3D可视化技术辅助腹腔镜下巨大肾上腺肿瘤切除术的临床可行性与有效性。方法回顾性分析2018年7月—2021年3月在中南大学湘雅医院行腹腔镜下巨大肾上腺肿瘤切除术的54例患者的临床资料,根据其术前是否行3D可视化技术重建分为3D可视化组和CT组。两组患者术前均行全腹部增强CT,3D可视化组利用CT图像数据建立3D可视化模型。3D可视化组患者术中运用3D可视化技术通过经腹腔或后腹腔途径行腹腔镜下巨大肾上腺肿瘤切除术,术中精准定位解剖结构,精准分离血管、完整切除肿瘤。结果两组患者均顺利完成手术,无中转开腹。3D可视化组术后住院时间与手术时间均短于CT组(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05)。3D可视化组经后腹腔途径入路患者的术中出血量、术后住院时间和手术时间优于CT组(P<0.05);3D可视化组经腹腔途径入路患者的术后住院时间和手术时间短于CT组(P<0.05)。结论3D可视化技术辅助腹腔镜下巨大肾上腺肿瘤切除术能缩短患者术后住院时间和手术时间。经后腹腔途径较经腹腔途径能更好地发挥3D可视化技术优势。

Objective To analyze the clinical feasibility and effectiveness of 3D visualization technology assisted laparoscopic resection of giant adrenal tumors.Methods The clinical data of 54 patients who underwent laparoscopic resection of giant adrenal tumor in Xiangya Hospital of Central South University from July 2018 to March 2021 were retrospectively analyzed,and they were divided into 3D visualization group and CT group according to whether 3D visualization technology had been applied before surgery.The patients all received preoperative whole-abdominal contrast-enhanced CT,and the CT data in 3D visualization group was used to establish the 3D visualization model.This technique was used to perform laparoscopic resection of giant adrenal tumors through transabdominal or retroperitoneal approaches,and accurate positioning of anatomical structure,accurate separation of blood vessels and complete resection of tumor were performed during the operation.Results All the operations were successfully carried out in patients of the two groups without conversion to open surgery.The operative duration and postoperative length of hospital stay of the 3D visualization group were shorter than those of the CT group(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).Compared with CT group,the intraoperative blood loss was less,and operative duration and postoperative length of hospital stay were shorter in 3D visualization group with retroperitoneal approach,whereas the operative duration and postoperative length of hospital stay were shorter in 3D visualization group with transabdominal approach(P<0.05).Conclusions The application of 3D visualization technology to assist laparoscopic resection of giant adrenal tumors can help reduce the operative duration and postoperative length of hospital stay.Compared with the transabdominal approach,the retroperitoneal approach makes better use of the advantages of 3D visualization technology.