全息影像术中导航在泌尿外科腹腔镜和机器人手术中的应用价值  

Application of holographic image navigation in urological laparoscopic and robotic surgery

作　　者：朱刚[1] 邢金春[2] 翁国斌 胡志全[4] 李宁忱[5] 朱鹤[5] 高平生[6] 王志华 朱伟智 张凯[1] 李鸿波 吴准[2] 朱瑞 魏希锋[6] 王亚楠 谢群 傅斌[8] 王行环[9] 齐琳[10] 姚欣[11] 潘铁军 王德林[13] 刘南 邱剑光 杨江根 张保[17] 刘卓炜[18] 韩辉[18] 李刚[19] 张滨[20] 那曼丽 陆菁菁 汪磊[5] 赵子臣[5] 那彦群[5] Zhu Gang;Xing Jinchun;Weng Guobin;Hu Zhiquan;Li Ningchen;Zhu He;Gao Pingsheng;Wang Zhihua;Zhu Weizhi;Zhang Kai;Li Hongbo;Wu Zhun;Zhu Rui;Wei Xifeng;Wang Yanan;Xie Qun;Fu Bing;Wang Xinghuan;Qi Lin;Yao Xin;Pan Tiejun;Wang Delin;Liu Nan;Qiu Jianguang;Yang Jianggen;Zhang Bao;Liu Zhuowei;Han Hui;Li Gang;Zhang Bin;Na Manli;Lu Jingjing;Wang Lei;Zhao Zichen;Na Yanqun(Department of Urology,Beijing United Family Hospital,Beijing 100015,China;Department of Urology,The First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Urology,Ningbo Yinzhou No.2 Hospital,Ningbo 315192,China;Department of Urology,Tongji Medical College Huazhong University of Science&Technology,Wuhan 430030,China;Department of Urology,Peking University Shougang Hospital,Peking University Wu Jieping Urology Center,Beijing 100144,China;Department of Urology,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Urology,Zhuhai People's Hospital,Zhuhai 519000,China;Department of Urology,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Urology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Urology,XiangYa Hospital Central South University,Changsha 410008,China;Department of Urology,Tianjin Medical University Cancer Institute&Hospital,Tianjin 300060,China;Department of Urology,General Hospital of the Central Theater Command of the Chinese PLA,Wuhan 430070,China;Department of Urology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 430016,China;Department of Urology,Chongqing University Cancer Hospital,Chongqing 400030,China;Department of Urology,The Sixth Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510655,China;Department of Urology,Shenzhen Luohu People's Hospital,Shenzhen 518000,China;Department of Urology,Aerospace Central Hospital,Beijing 100049,China;Department of Urology,Sun Yat-Sen University Cancer Center,Guangzhou 510060,China;Department of Urology,The Second Hospital of Tianjin Medical University,Tia

机构地区：[1]北京和睦家医院泌尿外科,100015 [2]厦门大学附属第一医院泌尿外科,361003 [3]宁波市鄞州第二医院泌尿外科,315192 [4]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [5]北京大学首钢医院吴阶平泌尿外科医学中心,100144 [6]宁夏回族自治区人民医院泌尿外科,银川750002 [7]珠海市人民医院泌尿外科,519000 [8]南昌大学第一附属医院泌尿外科,南昌330006 [9]武汉大学中南医院泌尿外科,武汉430071 [10]w中南大学湘雅医院泌尿外科,长沙410008 [11]n天津医科大学附属肿瘤医院泌尿外科,300060 [12]解放军中部战区总医院泌尿外科,武汉430070 [13]重庆医科大学附属第一医院泌尿外科,400016 [14]重庆大学附属肿瘤医院泌尿外科,400030 [15]中山大学附属第六医院泌尿外科,广州510655 [16]深圳市罗湖区人民医院泌尿外科,518000 [17]n航天中心医院泌尿外科,北京100049 [18]中山大学肿瘤防治中心泌尿外科,广州510060 [19]天津医科大学第二医院泌尿外科,300211 [20]北京大学首钢医院医学影像科,100144 [21]北京和睦家医院影像科,100015

出　　处：《中华泌尿外科杂志》2020年第2期131-137,共7页Chinese Journal of Urology

摘　　要：目的探讨全息影像术中导航在泌尿外科腹腔镜和机器人手术中的应用价值。方法回顾性分析2019年1—12月北京和睦家医院等19家医疗中心收治的86例患者的病例资料,临床诊断包括肾肿瘤78例,膀胱癌2例,肾上腺肿瘤2例,肾囊肿1例,前列腺癌1例,汗腺癌淋巴结转移1例,根治性膀胱切除术后盆腔转移瘤1例。其中,32例接受标准腹腔镜手术,分别为肾部分切除术(LPN)27例,根治性前列腺切除术1例,根治性膀胱切除术2例,肾上腺肿瘤切除术2例;54例接受达芬奇机器人手术,分别为肾部分切除术(RAPN)51例,腹膜后淋巴结清扫术1例,双侧肾囊肿去顶减压术1例,盆腔转移肿瘤切除术1例。两种术式的肾部分切除术患者中41例有可统计的临床数据,其中RAPN 23例,LPN 18例。男26例,女15例;中位年龄53.5(24~76)岁;中位R.E.N.A.L评分7.8(4~11)分。专业工程师根据86例术前增强CT检查图像和诊断报告重建全息影像。术前,全息影像可帮助术者对供应肿瘤或手术切除部位的动静脉血管、淋巴结和神经的立体空间结构及相互关系有更直观的认识,协助术前手术规划。在术中将全息影像与腹腔镜监视器中的术野图像进行实时追踪和融合,实现术中导航。结果本组86例手术均顺利完成。术中通过人工调整全息影像,可提示重要血管如肾动脉和肾静脉在体内的投影位置,帮助术者定位血管、淋巴结和其他重要解剖结构的位置,便于精准分离。本研究采用标准腹腔镜手术和达芬奇机器人手术的肾部分切除术患者中共41例有可统计的临床数据。41例中位手术时间140(50~225)min,其中RAPN为140(50~215)min,LPN为160(80~225)min;中位热缺血时间23(14~60)min,其中RAPN为21(17~40)min,LPN为25(14~60)min;中位出血量80(5~1200)ml,其中RAPN为150(30~1200)ml,LPN为50(5~1200)ml。术中无周围重要脏器损伤。2例LPN患者出现ClavienⅡ级并发症,1例出血1200 ml给予输血,另一例血Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years(range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8(range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical

关 键 词：腹腔镜 三维影像重建 全息影像 腹腔镜手术 机器人手术 

分 类 号：R699[医药卫生—泌尿科学] TP242[医药卫生—外科学]