三维重建可视化技术联合3D腹腔镜在肝门部胆管癌根治术中的应用

Clinical application of 3D reconstruction visualization technology combined with 3D laparoscopy in the radical resection of hilar cholangiocarcinoma

目的探讨三维重建可视化技术联合3D腹腔镜在肝门部胆管癌根治术中的应用价值。方法回顾性分析2021年9月—2023年4月徐州市中心医院肝胆外科收治的11例行3D腹腔镜下肝门部胆管癌根治术患者的临床资料。术前应用三维重建可视化软件将患者腹部CT薄层增强扫描图像数据进行三维重建,立体显示肿瘤位置,观察肿瘤与周围脉管关系、肿大淋巴结及解剖变异情况,并制定具体的手术方式。所有患者均在3D腹腔镜下行肝门部胆管癌根治术。结果三维重建后可清楚地显示肝门部胆管肿瘤及其周围情况,特别是脉管结构及解剖变异,其中Bismuth分型Ⅰ型3例,Ⅲa型3例,Ⅲb型3例,Ⅳ型2例。所有患者均顺利完成3D腹腔镜下肝门部胆管癌根治术,无中转开腹,手术时间为(581.0±91.0)min,术中出血量为(840.0±280.0)ml,术后排气时间为(2.2±0.5)d,术后拔除引流管时间为(8.5±2.6)d,术后住院时间为(15.1±3.7)d。所有患者均达到R0切除,淋巴结清扫数量为(12.0±2.4)枚。术后有2例(Ⅲ型1例和Ⅳ型1例)胆汁漏,均予保守治疗后痊愈;术后2例胸腔积液,均对症治疗后痊愈;其余患者无术后出血、肠漏、切口感染和肺部感染等并发症发生。所有患者均康复出院,术后规律随访3~22个月,均生存良好,未见肿瘤复发和转移。结论三维重建可视化技术联合3D腹腔镜用于肝门部胆管癌根治术安全可行,值得进一步探讨。

Objective To explore the clinical value of three-dimensional(3D)reconstruction visualization technol-ogy combined with 3D laparoscopy in the radical resection of hilar cholangiocarcinoma.Methods A total of 11 patients who were admitted in Department of Hepatobiliary Surgery,Xuzhou Central Hospital from September 2021 to April 2023 and underwent radical resection of hilar cholangiocarcinoma by 3D laparoscopy were selected and their clinical data were retrospectively analyzed.Before operation,the CT enhanced thin-layer scanning image data of their abdomen were recon-structed by the 3D reconstruction visualization software.We determined the three-dimension location of the tumor,ob-served the relationship between tumor and surrounding vessels as well as the enlarged lymph nodes and anatomical abnor-mality,in order to determine the specific surgical approach and procedures.All the patients underwent radical resection of hilar cholangiocarcinoma under 3D laparoscopy.Results 3D reconstruction visualization clearly displayed hilar cholangiocarcinoma and the adjacent tissues,especially the vascular structure and anatomical abnormality.According to Bismuth classification,there were 3 cases of type I,3 cases of typeⅢa,3 cases of typeⅢb and 2 cases of typeⅣ.All the surgeries were successfully completed,without transfer to open surgery.The operative time was(581.0±91.0)min,the amount of intraoperative blood loss(840.0±280.0)ml,the time to first postoperative exhaust was(2.2±0.5)d,the time to postoperative drainage tube removal was(8.5±2.6)d and the length of postoperative hospitalization stay was(15.1±3.7)d.All the patients achieved R0 resection and the numbers of dissected lymph nodes were(12.0±2.4).Two patients(typeⅢ1 case and typeⅣ1 case)presented postoperative bile leakage,and were cured after conservative treatment.There were also two cases of pleural effusion which were cured after symptomatic treatment.The other patients had no complications such as postoperative bleeding,intestinal leakage,incision infection and pulmonary infection.All the patients were discharged and regularly followed-up for 3-22 months,with good survival,without relapse or metasta-sis.Conclusions 3D reconstruction visualization technology and 3D laparoscopy can be used in combination for the radi-cal resection of hilar cholangiocarcinoma,which is safe and feasible,and further studies are still needed to confirm bene-fits of this approach.