Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

With the continuous development of digital medicine,minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery.Due to the specificity and complexity of hepatobiliary surgery,traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions.Imaging-based three-dimensional(3D)reconstruction,virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment,improving the controllability and safety of intraoperative operations,and in difficult-to-reach areas of the posterior and superior liver,assistive robots reproduce the surgeon’s natural movements with stable cameras,reducing natural vibrations.Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment.We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.

Accuracy of pedicle screw placement in Lenke 1 adolescent idiopathic scoliosis surgery using intraoperative navigation with a simple calibration technique

Objective:To compare the position and the grade of screw perforation in Lenke 1 adolescent idiopathic scoliosis(AIS)surgery using intraoperative navigation system with and without calibration technique,and to explore the related factors of navigation deviation and the clinical significance of calibration technique.Methods:From 2014 to 2017,a total of 45 Lenke 1 AIS surgical cases were enrolled in this study.The 23 surgical cases were assisted with intraoperative navigation system(Navigation group)and another 22 cases received surgery using intraoperative navigation system with calibration technique(Calibration group).In two groups,the basic information and radiological data were all recorded.Postoperative CT scan with 3D reconstruction was used to analyze the accuracy of pedicle screw placement,as well as the length and position of cortical perforation.Results:There was no statistical difference between two groups in gender,age,Risser sign,both preoperative Cobb angles and flexibility of the major curve,as well as numbers of pedicle screws.477 and 469 pedicle screws were implanted in the navigation group and the calibration group respectively.The rate for major pedicle perforations 2 mm(grades 2,3)was 7.8%in navigation group.It was statistically significant difference from the 4.3%screw misplacement in calibration group(P=0.014).In navigation group,the rates of major pedicle perforations 2 mm were medial:3.4%,lateral:3.6%and anterior:0.6%respectively.The corresponding rates were 1.1%,2.6%and 0.4%in calibration group respectively.The rates of the medial cortical perforation 2 mm showed statistical difference between two groups(P=0.016).No serious complications,such as nerve or vascular injury,were found in all patients.Conclusion:Intraoperative navigation system with calibration technique provides the real-time monitoring of navigation deviation,the higher accuracy of pedicle screw insertion,the lower medial cortical perforation rate and the less complication rate,as well as a simple calibration technique with higher accuracy of screw placement in comparison to intraoperative navigation system for Lenke 1AIS surgery.

Up-to-date intraoperative computer assisted solutions for liver surgery

Computer assisted surgical planning allowed for a better selection of patients,evaluation of operative strategy, appropriate volumetric measurements,identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2 D images and 3 D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.

Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic diseases.METHODS:This study included 15 patients with biliary and pancreatic diseases.RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume data.The ultrasound used was EUB-8500with a convex probe EUP-C514.The RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in position.RESULTS:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures.The resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better visualization.CONCLUSION:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

Precise Point Positioning Technique with IGS Real-Time Service (RTS) for Maritime Applications

The maritime navigation accuracy requirements for radionavigation systems such as GPS are specified by the International Maritime Organization (IMO). Maritime navigation usually consists of three major phases identified as Ocean/Coastal/Port approach/Inland waterway, in port navigation and automatic docking with an accuracy requirement that ranges from 10 m to 0.1 m. With the advancement in autonomous GPS positioning techniques such as Precise Point Positioning (PPP) and with the advent of the new IGS-Real-Time-Service (RTS), it is necessary to assess the possibility of a wider role of the PPP-based positioning technique in maritime applications. This paper investigates the performance of an autonomous real-time PPP-positioning solution by using the IGS- RTS service for maritime applications that require an accurate positioning system. To examine the performance of the real-time IGS-RTS PPP-based technique for maritime applications, kinematic data from a dual frequency GPS receiver is investigated. It is shown that the real-time IGS-RTS PPP-based GPS positioning technique fulfills IMO requirements for maritime applications with an accuracy requirement ranges from 10 m for Ocean/Coastal/Port approach/Inland waterways navigation to 1.0 m for in port navigation but cannot fulfill the automatic docking application with an accuracy requirement of 0.10 m. To further investigate the real-time PPP-based GPS positioning technique, a comparison is made between the real-time IGS-RTS PPP-based positioning technique and the real-time PPP-based positioning by using the predicted part of the IGS Ultra-Rapid products and the real-time GPS positioning technique with the Wide Area Differential GPS service (WADGPS). It is shown that the IGS-RTS PPP-based positioning technique is superior to the IGS-Ultra-Rapid PPP-based and WADGPS-based positioning techniques.

uNavigator双导航系统在困难部位腹腔镜肝切除术的初步应用

目的探讨uNavigator双导航系统在腹腔镜肝切除术围手术期的应用价值。方法对1例53岁女性病人采用uNavigator双导航系统行腹腔镜肝切除术。该例病人因“体检发现肝脏占位2 d”就诊,有腰椎间盘突出症病史,术前血常规、凝血功能、肝功能和肾功能均正常,通过术前腹部增强CT诊断为11.2 cm的肝海绵状血管瘤,位于肝右叶,靠近右后、右前肝蒂及肝右静脉。根据腹部增强CT的DICOM数据重建病人肝脏的增强现实全息影像,用于医患沟通、术前手术规划和术中导航。于2024年1月25日行uNavigator双导航系统引导下腹腔镜肝右后叶及右前叶背侧段切除术。术后病理证实为肝海绵状血管瘤。结果利用三维图像与实际肝脏的融合图像标记血管瘤的左侧边界、右前和右后肝蒂的走行。使用超声刀沿边界离断肝实质,采用Endo-GIA切断右后肝蒂及肝右静脉主干。手术时间为180 min,出血量约300 mL。术后病人恢复良好,术后第8天出院。结论uNavigator双导航系统可促进医患沟通,帮助医生术前规划和术中导航。

Current use of intraoperative ultrasound in modern liver surgery

Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries.

Accuracy and complications of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy-based navigation

Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for posterior C2 fixation. Chin Med J 2014;127 （14）： 2654-2658

Posterior Reduction and Monosegmental Fusion with Intraoperative Three-dimensional Navigation System in the Treatment of High-grade Developmental Spondylolisthesis

Background： The treatment of high-grade developmental spondylolisthesis （HGDS） is still challenging and controversial. In this study, we investigated the efficacy of the posterior reduction and monosegmental fusion assisted by intraoperative three-dimensional （3D） navigation system in managing the HGDS. Methods： Thirteen consecutive HGDS patients were treated with posterior decompression, reduction and monosegmental fusion ofL5/S1, assisted by intraoperative 3D navigation system. The clinical and radiographic outcomes were evaluated, with a minimum follow-up of 2 years. The differences between the pre- and post-operative measures were statistically analyzed using a two-tailed, paired t-test. Results： At most recent follow-up, 12 patients were pain-free. Only l patient had moderate pain, There were no permanent neurological complications or pseudarthrosis. The magnetic resonance imaging showed that there was no obvious disc degeneration in the adjacent segment. All radiographic parameters were improved. Mean slippage improved from 63.2% before surgery to 12.2% after surgery and 11.0% at latest follow-up. Lumbar lordosis changed from preoperative 34.9 ± 13.3° to postoperative 50.4 ±9.9°, and 49.3 ± 7.8° at last follow-up. L5 incidence improved from 71.0 ± 11.3° to 54.0 ± 1 1.9° and did not change significantly at the last follow-up 53.±1 15.4°. While pelvic incidence remained unchanged, sacral slip significantly decreased from preoperative 32.7± 12.5° to postoperative 42.6 ± 9.8°and remained constant to the last follow-up 44.4 ± 6.9°. Pelvic tilt significantly decreased from 38.4±12.5° to 30.9± 8.1° and remained unchanged at the last fbllow-up 28.1± 11.2°. Conclusions： Posterior reduction and monosegmental fusion of L5/S1 assisted by intraoperative 3D navigation are an effective technique for managing high-grade dysplastic spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal balance can be achieved.

Navigated liver surgery:State of the art and future perspectives

Background:In recent years,the development of digital imaging technology has had a significant influence in liver surgery.The ability to obtain a 3-dimensional(3D)visualization of the liver anatomy has provided surgery with virtual reality of simulation 3D computer models,3D printing models and more recently holograms and augmented reality(when virtual reality knowledge is superimposed onto reality).In addition,the utilization of real-time fluorescent imaging techniques based on indocyanine green(ICG)uptake allows clinicians to precisely delineate the liver anatomy and/or tumors within the parenchyma,applying the knowledge obtained preoperatively through digital imaging.The combination of both has transformed the abstract thinking until now based on 2D imaging into a 3D preoperative conception(virtual reality),enhanced with real-time visualization of the fluorescent liver structures,effectively facilitating intraoperative navigated liver surgery(augmented reality).Data sources:A literature search was performed from inception until January 2021 in MEDLINE(Pub Med),Embase,Cochrane library and database for systematic reviews(CDSR),Google Scholar,and National Institute for Health and Clinical Excellence(NICE)databases.Results:Fifty-one pertinent articles were retrieved and included.The different types of digital imaging technologies and the real-time navigated liver surgery were estimated and compared.Conclusions:ICG fluorescent imaging techniques can contribute essentially to the real-time definition of liver segments;as a result,precise hepatic resection can be guided by the presence of fluorescence.Furthermore,3D models can help essentially to further advancing of precision in hepatic surgery by permitting estimation of liver volume and functional liver remnant,delineation of resection lines along the liver segments and evaluation of tumor margins.In liver transplantation and especially in living donor liver transplantation(LDLT),3D printed models of the donor’s liver and models of the recipient’s hilar anatomy can contribute further to improving the results.In particular,pediatric LDLT abdominal cavity models can help to manage the largest challenge of this procedure,namely large-for-size syndrome.

RRVPE:A Robust and Real-Time Visual-Inertial-GNSS Pose Estimator for Aerial Robot Navigation

Self-localization and orientation estimation are the essential capabilities for mobile robot navigation.In this article,a robust and real-time visual-inertial-GNSS(Global Navigation Satellite System)tightly coupled pose estimation(RRVPE)method for aerial robot navigation is presented.The aerial robot carries a front-facing stereo camera for self-localization and an RGB-D camera to generate 3D voxel map.Ulteriorly,a GNSS receiver is used to continuously provide pseudorange,Doppler frequency shift and universal time coordinated(UTC)pulse signals to the pose estimator.The proposed system leverages the Kanade Lucas algorithm to track Shi-Tomasi features in each video frame,and the local factor graph solution process is bounded in a circumscribed container,which can immensely abandon the computational complexity in nonlinear optimization procedure.The proposed robot pose estimator can achieve camera-rate(30 Hz)performance on the aerial robot companion computer.We thoroughly experimented the RRVPE system in both simulated and practical circumstances,and the results demonstrate dramatic advantages over the state-of-the-art robot pose estimators.

Current trends and key considerations in the clinical translation of targeted fluorescent probes for intraoperative navigation

The rapid development of fluorescence imaging for intraoperative navigation has spurred further development of targeted fluorescent probes in the past decade.Only a few nontargeted dyes,including indocyanine green and methylene blue,are currently applied for fluorescence guided surgery in the clinic.While no targeted fluorescent probes have been approved for the clinic,a number of them have entered clinical trials.These probes have emission wavelengths in the visible and near infrared(NIR)-I(700-900 nm)range.Among them,activatable probes and nanoprobes have generated special interest.Compared with NIR-I fluorescent probes,NIR-II(1000-1700 nm)fluorescent probes exhibit better intravital performance in terms of increased penetration depths,reduced tissue autofluorescence,and higher signalto-background ratios.However,more challenges are expected before the successful translation of NIR-II probes from bench to bedside.This review provides a brief overview of targeted fluorescent probes under clinical evaluation and recent achievements in the field of NIR-II fluorescence imaging.In addition,we outline key considerations concerning the design of fluorescent probes for clinical translation.

超声在脑深部肿瘤治疗中的应用进展

脑深部肿瘤是指生长于三脑室、松果体区、鞍区等深部结构处的肿瘤,周围毗邻重要神经、血管结构,手术难度高,术后并发症多,其治疗往往是以手术为主辅以放化疗的综合治疗。超声不仅可以识别肿瘤的大小、形状、位置和深度,帮助医师更精确地定位和切除肿瘤,减少手术损伤,还可以辅助肿瘤治疗药物跨越血脑屏障进入靶向部位,甚至直接消融肿瘤。本文主要从非手术应用和手术应用两方面综述超声在脑深部肿瘤治疗中的应用进展。

近红外二区小分子有机探针IR-PEG-FA在肝癌术中导航中的应用

目的探讨近红外二区(NIR-Ⅱ)小分子有机探针IR-PEG-FA(IPF)在肝癌术中导航的应用潜力,并进行体内近红外荧光(NIRF)成像研究和体内外生物安全性评估。方法在课题组的研究基础上,通过化学合成方法构建一种靶向肝癌特异性生物标志物的NIR-Ⅱ小分子有机探针。用MTT法检测该纳米探针对肝癌细胞株BEL-7402、HepG-2、HuH-7及正常肝细胞HL-7702活性的影响;通过溶血实验、急性毒性实验和血生化检测对纳米探针的体内生物相容性进行评估;建立小鼠原位肝癌模型,分为IPF实验组、IP对照组、生理盐水对照组,实验组尾静脉注射IPF,对照组尾静脉分别注射IP和生理盐水,随后利用NIR-Ⅱ窗口成像技术检测其纳米探针IPF的特异肿瘤靶向性;最后在NIRF操作窗口下进行实时导航切除肝细胞肿瘤。结果纳米探针IPF对BEL-7402、HepG-2、HuH-7及HL-7702细胞无明显毒性,溶血率均低于3%的安全限度,未引起显著红细胞损伤;急性毒性实验中小鼠无异常行为和死亡情况,且对各重要脏器(心、肝、脾、肺、肾)正常结构和功能未产生明显影响;小鼠肝功和肾功血生化指标均在正常范围内;利用IPF纳米探针进行肝肿瘤细胞标记,在NIRF窗口下观察到肝癌细胞的荧光信号,手术后切除区域的荧光信号消失。结论NIR-Ⅱ小分子有机探针IPF具有良好的细胞安全性、优异的生物相容性,能够高效地标记肝癌细胞,具备肝癌术中导航潜力,能够为肝癌治疗的相关研究提供借鉴。

吲哚菁绿荧光显像技术在腹腔镜胆囊切除术中的应用初探

目的评价吲哚菁绿(indocyanine green,ICG)荧光显像技术在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中对肝外胆管显像的临床价值。方法回顾性分析2019年1月至2019年5月乐山市人民医院收治的30例在ICG荧光显像技术导航下完成LC的患者临床资料。术前外周静脉注射ICG,术中利用近红外光三维显像胆总管及胆囊管结构。结果行LC的30例患者中有27例(90%)术中胆囊管及胆总管均经ICG显像成功;2例胆囊管未显像,胆总管显像;1例胆囊管与胆总管均未显像。平均手术时间为35(27-65)min,术中平均出血量为3(0-10)mL,术后平均住院时间为3(2-5)d。术后患者恢复顺利,1例脐部伤口红肿,其余患者术后随访1-5个月无并发症发生。结论 LC术中利用ICG荧光显像技术可以实现术中对胆总管及胆囊管的早期定位显像,有助于术中实现对肝外胆管系统的可视化,避免术中因对肝外胆管显示不清引发的医源性肝外胆管损伤,保障手术安全,具有良好的应用前景。

脊柱畸形手术术中CT导航与徒手椎弓根置钉准确性比较

目的通过与徒手置钉的比较,探讨在后路全椎弓根钉治疗脊柱畸形手术术中CT导航下置钉的准确性优势及临床价值。方法回顾性分析2009-2012年我科连续100例接受脊柱矫形手术并行术中CT的患者。所有病例分为导航组和非导航组,其中导航组37例,非导航组63例。根据椎弓根钉置入节段的不同,将两组各分为胸椎、上胸椎、中胸椎、下胸椎及腰椎5个亚组,比较并分析两组整体间及各亚组间椎弓根螺钉的置钉准确性。结果导航组总体椎弓根置钉准确率(94.61%)高于非导航组(88.43%)(P<0.05),返修率(2.43%)低于非导航组(6.06%)(P<0.05);各亚组间比较,导航胸椎组、中胸椎组、下胸椎组椎弓根置钉准确率均高于非导航相对应组(P<0.05),返修率均低于非导航相对应组(P<0.05);两组上胸椎组间及腰椎组间准确率及返修率差异均无统计学意义。结论术中CT导航可提高脊柱畸形矫形手术中的椎弓根螺钉置钉准确性,尤其是胸椎弓根置钉的准确性。

荧光导航下切除胶质母细胞瘤及分子病理的表达意义

目的分析胶质母细胞瘤(GBM)分子病理在不同荧光显影区域的表达差异,探讨应用荧光导航技术在GBM手术中的临床意义。方法回顾性选取荧光素钠导航下经显微手术切除经病理确诊的21例GBM,对不同肿瘤区域的荧光强度和分子病理标志物表达进行比较。结果肿瘤全切除19例,次全切除2例。GBM荧光表现:肿瘤实质呈强荧光18例,弱或无荧光3例;瘤脑边界呈强荧光14例,弱或无荧光7例;瘤周水肿强荧光显影2例,弱荧光或无荧光显影19例(P<0.05)。免疫组织化学检测结果提示:不同肿瘤区域的P53、胶质纤维酸性蛋白(GFAP)和CD28表达水平差异无统计学意义(P>0.05),而Ki-67表达水平差异有统计学意义(P<0.05);在不同荧光强度GBM组织中,Ki-67表达水平差异也有统计学意义(P<0.05)。结论应用荧光素钠标记GBM,利于判断肿瘤边界;不同肿瘤区域和荧光强度的GBM,其分子病理表达具有差异,为荧光导航术中更准确辨析肿瘤浸润程度,增加安全切除范围提供病理学依据。

术中高场强磁共振联合锥体束导航在丘脑胶质瘤切除手术中的应用

目的探讨术中高场强磁共振联合锥体束导航在丘脑胶质瘤切除手术中的应用价值。方法回顾性研究2009年3月-2014年4月本院神经外科收治的28例接受1.5 T高场强术中磁共振联合锥体束导航辅助显微切除手术的丘脑胶质瘤患者临床资料,分析评估了所有患者的肿瘤切除程度、术前术后行为状态评分(Karnofsky performance scale,KPS)和肌力。结果 28例患者中有22例术中扫描后发现肿瘤残留,其中15例患者的残留肿瘤得以进一步切除,提高了肿瘤切除程度。术后3周,22例神经功能改善或同术前,6例神经功能下降,但是功能下降者KPS均>60,即生活均可自理。结论术中高场强磁共振联合锥体束导航有助于提高丘脑胶质瘤切除程度,减少术后运动功能障碍的发生率。

3D打印模型联合吲哚菁绿荧光导航行腹腔镜下精准肝切除术

目的探讨三维(three-dimensional,3D)打印模型联合吲哚菁绿(indocyanine green,ICG)荧光导航在腹腔镜下精准肝切除术中的临床应用价值。方法基于CT数据建模,采用镂空技术1:1打印出1例肝内胆管结石的3D肝脏模型,进行术前规划,并联合ICG荧光导航行腹腔镜下精准肝切除术。回顾性分析手术方案的制定及术中、术后临床资料。结果基于3D打印肝脏模型,手术方案从肝V/VIII段切除改为肝V段切除。3D打印模型与肝内结构吻合,可直视肝内复杂管道,联合ICG术中导航顺利完成腹腔镜下精准肝切除术。手术时间约210 min,其中肝切除时间约100 min,术中出血量约50 mL,术中无输血。术后无腹腔出血、腹腔感染、胆漏等并发症。结论采用3D打印肝脏模型联合ICG荧光导航为腹腔镜下精准肝切除术提供了一种新技术。