基于CT图像应用Mimics软件的三维重建技术在腹腔镜直肠癌D3根治术中的价值  

Application value of CT image-based three-dimensional reconstruction technology of Mimics software in laparoscopic D3 radical resection for rectal cancer

作　　者：陈佳佳[1,2] 陈志安 郭伟毅 肖晴 邓汉闻 李严兵 黄文华 CHEN Jiajia;CHEN Zhi′an;GUOWeiyi;XIAO Qing;DENG Hanwen;LI Yanbing;HUANGWenhua(Department of General Surgery,Affiliated Chaozhou Central Hospital of SouthernMedical University,Chaozhou 521000,China;National Key Discipline of Human Anatomy,School of Basic Medical Sciences,Southern Medical University,Guangzhou 510515,China;The First Clinical Medicine Colleage,Southern Medical University,Guangzhou 510515,China;Biomedical Engineering Colleage,Southern Medical University,Guangzhou 510515,China;Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center,Guangzhou 510515,China;Department of Human Anatomy,School of Basic Medical Sciences,Guangdong Medical University,Zhanjiang 524023,China)

机构地区：[1]南方医科大学附属潮州市中心医院普外二科,广东潮州521000 [2]南方医科大学基础医学院人体解剖学国家重点学科,广东广州510515 [3]南方医科大学第一临床医学院,广东广州510515 [4]南方医科大学生物医学工程学院,广东广州510515 [5]广东省医学3D打印应用转化工程技术研究中心,广东广州510515 [6]广东医科大学基础医学院人体解剖教研室,广东湛江524023

出　　处：《中国医学物理学杂志》2019年第7期778-783,共6页Chinese Journal of Medical Physics

基　　金：国家重点研发计划(2017YFC1103400);广东省科技计划项目(2016B090917001,2017B090912006,2018B090944002);深圳市医疗卫生“三名工程”高层次医学团队(SZSM201612019);广州市科技计划项目(201707010066)

摘　　要：目的:利用Mimics软件进行肠系膜下动脉(IMA)三维重建,并评估其在腹腔镜直肠癌D3根治术中的应用价值。方法:回顾性分析2016年6月至2018年1月期间行腹部增强CT检查的71例直肠癌患者的影像学资料,利用Mimics软件对该影像数据行IMA三维重建,归纳总结4种IMA分支类型所占的比例,并测量IMA根部到腹主动脉分叉的直线距离以及IMA根部至左结肠动脉(LCA)的直线距离。然后,将2018年1月~8月入院的30例直肠癌患者随机分成对照组(术前未行IMA三维重建)和观察组(术前根据IMA三维重建制定手术方案),每组15例。前瞻性分析两组患者的术中相关指标(手术时间、术中出血量、术中定位IMA及LCA的时间)以及术后相关观察指标(术后排气时间、术后引流管渗出量以及吻合口漏和肠梗阻的发生率)的差异,从而进一步评价术前IMA三维重建技术在直肠癌D3根治术中的应用。结果:在4种IMA分支分型中,Ⅰ型和Ⅲ型是相对比较常见的类型,而Ⅳ型则比较少见;IMA的分支分型与IMA根部至LCA的直线距离有相关性。此外,与对照组相比,术前行IMA三维重建可以明显缩短腹腔镜直肠癌根治术总时间[(152.00±18.16)minvs(135.53±14.06)min,P=0.010];同时,术前IMA三维重建有助于缩短术中对IMA和LCA的定位时间(P=0.004,0.006)、术后排气时间(P=0.029),并减少引流管渗出量(P=0.001)。结论:利用Mimics软件行IMA三维重建更便于术者准确评估患者IMA的分支类型及解剖定位,并在术中提供重要决策信息,进而明显缩短手术时间,提高直肠癌根治术的安全性。Objective To evaluate the application value of the three-dimensional (3D) reconstruction of inferior mesenteric artery (IMA) via Mimics software in laparoscopic D3 radical resection for rectal cancer.Methods Aretrospective analysis was performed on the imaging data of 71 patients with rectal cancer who underwent abdominal contrast-enhanced CT examination during June 2016 to January 2018.The 3D reconstruction of IMA which was obtained with Mimics software based on the imaging data was used to analyze the proportions of 4 different branch types of IMA,and measure the linear distance from IMA root to abdominal aortic bifurcation and to the left colon artery (LCA).Thirty patients with rectal cancer admitted to hospital from January 2018 to August 2018 were randomly divided into control group (without the 3D reconstruction of IMAbefore surgery) and observation group (before surgery,the surgical program was established according to the 3D reconstruction of IMA),with 15 patients in each group.A prospective analysis was performed on the differences in intraoperative and postoperative related indicators,thereby further evaluating the application of preoperative 3D reconstruction of IMAin laparoscopic D3 radical resection for rectal cancer. The intraoperative related indicators included operation time,intraoperative blood loss,intraoperative localizations of IMA and LCA,and the postoperative related indicators included postoperative exhaust time,postoperative drainage tube exudation and the incidence of anastomotic leakage and intestinal obstruction.Results Among the 4 IMA subtypes,type I and type III were relatively common,while type IV was rare.The branch type of IMA was related to the linear distance from IMA root to LCA. In addition,compared with control group,the 3D reconstruction of IMA before surgery significantly shortened operation time [(152.00±18.16) min vs (135.53±14.06) min,P=0.010].Meanwhile,preoperative 3D reconstruction of IMA was conductive to shortening the time for the localizations of IMA and LCA (P=0

关 键 词：直肠癌 肠系膜下动脉 MIMICS软件 三维重建 

分 类 号：R319[医药卫生—基础医学] R739.9