三维可视化技术在肾上腺静脉采血中的应用

The potential application of a three-dimensional visualization technique in adrenal vein sampling

目的探讨三维可视化技术在肾上腺静脉采血(AVS)中的应用价值。方法回顾性分析2017年12月至2020年5月在贵州省人民医院行AVS的76例患者的临床资料。所有患者均行肾上腺薄层增强CT检查并行双侧AVS。其中46例在双侧AVS前由专业工程师将肾上腺薄层增强CT数据进行三维可视化处理,30例未进行三维可视化处理。比较两组患者导管在位率、采血成功率、采血时间、造影剂用量、手术并发症等指标。结果76例患者中,男、女各38例,平均年龄45(25~57)岁。与非三维可视化组相比,三维可视化组右肾上腺静脉插管成功率(78%比43%)和AVS成功率(83%比53%)均较高,术中造影剂用量[M(Q_(1),Q_(3))为28(16,51)比78(59,89)ml]较低,采血所用时间[M(Q_(1),Q_(3))为44(22,61)比70(66,88)min]较短(均P<0.05)。与非三维可视化组相比,三维可视化组左侧肾上腺静脉插管导管在位率由97%提高至98%,AVS成功率由97%升至98%,采血时间及造影剂用量两组差异均无统计学意义(均P>0.05)。所有患者中,仅非三维可视化组有1例患者发生造影剂外渗,其余无明显并发症。结论AVS前将肾上腺薄层增强CT的数据进行三维可视化处理,可提高右侧AVS的成功率,减少造影剂的使用量,并缩短AVS的手术时间,具有较高的临床应用价值。

Objective To explore the potential application of a three-dimensional visualization technique in adrenal vein sampling(AVS).Methods The clinical data were retrospectively analyzed,which included 76 patients with primary aldosteronism(PA)who have undergone AVS in Guizhou Provincial People′s Hospital from December 2017 to May 2020.All cases were examined by adrenal thin-section enhanced CT and blood was drawn by bilateral AVS.Among them,the adrenal vein blood of 46 cases was sampled with the help of three-dimensional(3D)visualization processing of CT data,while that of 30 cases was without 3D visualization processing.The rate of the catheter in place,the successful rate of AVS,the time of blood collection,the dosage of the contrast agent,and surgical complications were compared between the two groups.Results There were 76 cases included,while 38 were male and 38 were female.The average age was 45(25-57)years.Compared with the patients without the aid of 3D visualization,the success rate of right AVS of the patients with the aid of 3D visualization technology increased from 43%to 78%(P<0.05).The success rate of adrenal vein blood collection increased from 53%to 83%.The dose of contrast agent decreased[the M(Q_(1),Q_(3))were78(59,89)ml vs 28(16,51)ml,P<0.05],and the time of blood sampling from the right adrenal vein approximately decreased[the M(Q_(1),Q_(3))were 70(66,88)min vs 44(22,61)min,P<0.05].Compared with the case without the aid of 3D visualization,the left adrenal vein catheterization rate of patients in the 3D visualization group increased from 97%to 98%,the success rate of adrenal vein blood collection increased from 97%to 98%,and the differences of the time of blood sampling and the dosage of the contrast were not statistically significant between the two groups.Among all the cases experienced bilateral AVS,only one patient without 3D reconstruction had contrast extravasation,and the others had no obvious complications.Conclusions Before AVS,3D visualization processing of adrenal vein from CT data is capable of increasing the success rate of blood sampling from the right adrenal vein,as well as reducing the dosage of contrast agent and the time of adrenal vein blood sampling.Therefore,it has a potential clinical value of the application.