移动式三维X射线诊断设备在腹腔镜卵巢畸胎瘤剔除术中的应用分析

Application of Mobile Three-Dimensional X-Ray Apparatus for Positioning of Ovarian Teratoma in Laparoscopic Surgery

[目的]探讨一种操作简单、安全、准确、无创的腹腔镜下卵巢畸胎瘤剔除术中(畸胎瘤直径≤3 cm)定位方法,规划卵巢表面切口路径,降低手术副损伤。[方法]收集5例在浙江大学医学院附属第四医院行腹腔镜卵巢畸胎瘤剔除术患者,术中应用移动式三维X射线诊断设备行盆腔断层扫描成像,由两名影像诊断医生对图像质量进行评价,分为优、良、差三级。结合图像判读肿瘤与其相邻组织的相对关系行定位标注,规划卵巢表面切口行畸胎瘤剔除术,依据一次切口选择准确来评价定位准确性;同时由操作者对设备进行性能评价(便携性及稳定性)。[结果]5例受试者中1例成像质量评价为差而无法准确定位,4例图像质量优,判读定位结果及拟定手术切口与术中情况均符合,引导实施精准手术,无盲目选定切口及非必要延长切口。设备在运行过程中性能稳定,未发生影响手术进程的不良事件。[结论]移动式三维X射线诊断设备性能稳定,其在腹腔镜卵巢畸胎瘤剔除术中盆腔扫描成像清晰,可精准定位肿瘤,指引术者规划卵巢切口路径,降低因无法准确判断肿瘤位置所致的“无效”卵巢切口而导致的副损伤,从而保护卵巢功能。

[Objective]To explore an operationally simple,safe,accurate and non-invasive method for positioning of ovarian teratoma during laparoscopic ovarian teratoma removal(teratoma diameter≤3 cm),in order to plan the incision path on the ovarian and reduce the surgical complications.[Methods] Five patients undergoing laparoscopic teratoma resection in the Fourth Affiliated Hospital of Zhejiang University were selected and pelvic tomography imaging was performed using mobile three-dimensional X-ray during the operation.The image quality was evaluated by two radiologists and was categorized into three levels:excellent,good and bad.Based on the relative relationship between the tumor and adjacent tissues as visualized on the images,the surgeons made surgical incisions on ovarian.The accuracy of localization was evaluated based on the success rate of selecting the corect incision site in a single attempt.The performance of the device was also evaluated by the operator in terms of its portability and stability.[Results]Among the five participants,1 case had bad image quality evaluation and therefore could not be accurately positioned,while the remaining 4 cases had excellent image quality.The tumor localization results and surgical incision plans were consistent with the preoperative diagnosis and intraoperative evaluation,ensuring precise surgical implementation without requiring the blind selection of incision sites or the unnecessary extension of incision.The device has stable performance and no adverse events had occurred that affect the progress of the surgery.[Conclusion]The mobile three-dimensional X-ray diagnostic device which was used in laparoscopic ovarian teratoma removal has stable performance and can provide pelvic tomography imaging that was suitable for tumor localization.It enables the accurate location of the tumor to aid in the planning of the surgical path,solving the problems faced due to the unclear location of the tumor and reducing secondary damage from surgery,thereby protecting ovarian function.