胸腹主动脉混合现实技术在Stanford A型主动脉夹层中的应用

Application of thoracoabdominal aorta mixed reality technique in aortic dissection

目的:探究胸腹主动脉混合现实技术和计算机断层血管造影(computed tomography angiography,CTA)技术在Stanford A型主动脉夹层诊治中的临床应用价值。方法:回顾性收集行胸腹主动脉混合现实和CTA检查的患者80例,将患者分为A组(胸腹主动脉混合现实组)和B组(胸腹主动脉CTA组)。A组将生成的CTA数据导入至可视化三维(three-dimensional,3D)建模软件进行3D建模,并完成混合现实结果发布;B组则进行胸腹主动脉3D-CT重建技术。采用独立样本t检验对两组患者一般资料进行分析。两组计数资料采用χ^(2)检验;等级资料采用Wilcoxon检验。Kruskal-Wallis检验用于比较连续变量。评价者的主观一致性评价采用Kappa检验。对两组的围手术期指标和临床应用价值进行比较。结果:两组在年龄、体质量、身高、性别、体质量指数、高血压、心血管疾病、脑血管疾病、糖尿病和DeBakey分型指标上差异均无统计学意义(均P>0.05)。A组在手术时间、体外循环辅助时间、主动脉阻断时间、选择性脑灌注时间和术中血浆输注指标上较B组分别减少约15%、24%、20%、22%和20%。A组在手术方案制定、术中实时导航、远程会诊和医患沟通四方面的临床应用价值进行主观评分均高于B组(均P<0.05)。结论:胸腹主动脉混合现实技术在急性Stanford A型手术治疗上,较传统胸腹主动脉CTA可更有效地改善围手术期指标,同时在手术方案制定、术中实时导航、远程会诊和医患沟通上更具优势。

Objective:To explore the clinical application value of mixed reality technique and computed tomography angiography(CTA)technology in the diagnosis and treatment of Stanford type A aortic dissection(STAAD).Methods:Eighty patients with thoracoabdominal aorta mixed reality or CTA were retrospectively collected and were divided into group A(thoracoabdominal aorta mixed reality group)and group B(thoracoabdominal aorta CTA group)according to the different study purposes.CTA data generated by group A were import into visual three-dimensional(3D)modelling software for 3D modelling to complete the display of mixed reality results;Group B underwent 3D-CT reconstruction of thoracoabdominal aorta.The general data of the two groups of patients were analyzed by independent sample t test.Two groups of counting data were tested by χ^(2 )test.Wilcoxon test was used for grade data.Kruskal-Wallis test was used to compare continuous variables.Kappa test was used to evaluate the subjective consistency of the evaluator.The perioperative indicators and clinical application value of the two groups were compared.Results:There was no significant difference in age,weight,height,sex,body mass index,hypertension,cardiovascular disease,cerebrovascular disease,diabetes and DeBakey classification between the two groups(all P>0.05).Compared with group B,group A decreased about 15%,24%,20%,22%and 20%in operation time,extracorporeal circulation assistance time,aortic block time,selective cerebral perfusion time and intraoperative plasma infusion.The subjective score of the clinical application value of group A in the four aspects of operation plan formulation,real-time intraoperative navigation,remote consultation and doctor-patient communication was higher than that of group B(all P<0.05).Conclusion:Compared with traditional thoracoabdominal aorta CTA,thoracoabdominal aorta mixed reality can more effectively improve perioperative indexes in the treatment of acute STAAD operation,and has advantages in surgical plan formulation,real-time intraoperative navigation,remote consultation,and doctor-patient communication.