CTU+CTA联合成像结合3D打印技术在腹腔镜肾部分切除术中的应用  

Application of CTU+CTA Combined Imaging and 3D Printing in Laparoscopic Partial Nephrectomy

作　　者：陈一鸣[1] 宋广来[1] 王坤 陈真[1] 邢兆宇[1] 丁涛[1] CHEN Yi-ming;SONG Guang-lai;WANG Kun;CHEN Zhen;XING Zhao-yu;DING Tao(Department of Urology,Changzhou First People's Hospital,Changzhou,Jiangsu Province,213000 China)

机构地区：[1]常州市第一人民医院泌尿外科,江苏常州213000

出　　处：《中外医疗》2020年第12期183-186,共4页China & Foreign Medical Treatment

摘　　要：目的比较CTU+CTA联合成像与传统CT平扫+增强进行三维重建图像精度差异,评估CTU+CTA图像重建后3D打印肾脏模型在腹腔镜肾部分切除术手术规划及术前沟通中的应用价值。方法选取2018年6-7月期间入院的两名肾癌患者,术前行CTU+CTA检查,采集CT图像,同时回顾性采集5例2018年1-6月期间入院手术的5例肾癌患者术前CT平扫+增强图像,将采集到的图像进行三维重建,比较两者对肾脏及肿瘤细节的还原程度。而后利用CTU+CTA三维建模进行3D打印,评估3D打印模型还原程度、对手术规划的帮助及对术前沟通的帮助程度。结果CTA+CTU三维重建图像对肿瘤侵犯集合系统情况、肾脏形态、肾脏血管分支等评分项目中得分高于CT平扫+增强三维重建图像,两组比较差异有统计学意义(t=15.611,P<0.001)。3D打印肾脏模型经专家评分后模型1总分(40.38±1.49)分,模型2总分(41.13±1.93)分,达到合格标准以上且两者相比差异无统计学意义(t=0.615,P=0.516),3D打印肾脏模型术前沟通评分模型1总分(45.17±0.20)分,模型2总分(45.33±0.57)分,也达到合格标准以上且两者相比差异无统计学意义(t=0.447,P=0.686)。结论 CTU+CTA联合成像可提高三维重建及3D打印的精度,3D打印肾脏模型对肾癌手术规划及术前沟通可提供较好的帮助。Objective To compare the accuracy difference between 3D reconstruction images of CTU+CTA combined imaging and conventional CT plain scan+enhancement,and evaluate the 3D printed kidney model after CTU+CTA image reconstruction in the surgical planning and preoperative communication of laparoscopic nephrectomy value.Methods Two renal cancer patients admitted between June and July 2018 were examined by CTU+CTA before surgery,CT images were collected,and 5 cases of kidneys admitted to hospital between January and June 2018 were retrospectively collected.Pre-operative CT plain scan+enhanced image of cancer patients,3D reconstruction of the acquired images,comparison of the degree of reduction of kidney and tumor details.Then use CTU+CTA 3D modeling for 3D printing to evaluate the degree of 3D printed model restoration,help for surgical planning,and help for preoperative communication.Results The three-dimensional reconstruction images of CTA+CTU had higher scores on the scores of tumor invasion system,kidney morphology,and renal vascular branch than CT plain scan+enhanced three-dimensional reconstruction images.There was a significant statistical difference between the two groups(t=15.611,P<0.001).The 3D printed kidney model scored(40.38±1.49)by Model 1 and(41.13±1.93)by Model 2.After reaching the eligibility criteria,there was no significant difference between the two(t=0.615,P=0.516).3D printing preoperative communication score of kidney model was(45.17±0.20)points in Model 1 and(45.33±0.57)points in Model 2.It also reached the eligibility criteria and there was no significant difference between the two(t=0.447,P=0.686).Conclusion CTU+CTA combined imaging can improve the accuracy of 3D reconstruction and 3D printing.The 3D printed kidney model can provide better help for renal cancer surgery planning and preoperative communication.

关 键 词：3D打印 体层摄影尿路成像+血管造影 肾癌 腹腔镜肾部分切除术 

分 类 号：R4[医药卫生—临床医学]