CT三维重建辅助达芬奇机器人解剖性肺段切除术的临床应用  

Three-dimensional computed tomography reconstruction in robotic-assisted thoracoscopic anatomic pulmonary segmentectomy

作　　者：陈凯[1] 张亚杰[1] 项捷[1] 韩丁培[1] 金润森[1] 韩宇[1] 陈醒狮 李鹤成[1] Chen Kai;Zhang Yajie;Xiang Jie;Han Dingpei;Jin Runsen;Han Yu;Chen Xingshi;Li Hecheng(Department of Thoracic Surgery,Ruijin Hospital,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院胸外科,上海200025

出　　处：《中华解剖与临床杂志》2020年第3期260-264,共5页Chinese Journal of Anatomy and Clinics

基　　金：上海市卫生计生系统优秀学科带头人培养计划(2017BR055)。

摘　　要：目的探讨CT三维重建技术辅助达芬奇机器人解剖性肺段切除的可行性及临床效果。方法回顾性分析。纳入2017年5月—2018年9月上海交通大学医学院附属瑞金医院胸外科接受达芬奇机器人肺段切除术的肺结节患者47例,其中男16例、女31例,年龄(53.15±12.19)岁,均在术前依据CT影像资料完成肺三维重建,肺部结节最大径为(8.04±2.96)mm。术者依据重建影像设计并进行解剖性肺段切除术,收集分析患者一般临床特征及围手术期资料。结果术前CT三维重建可清晰显示肺部动、静脉和支气管的空间位置关系,可准确显示肺结节的位置和肺段边界。所有患者均根据术前CT三维重建影像设计并完成达芬奇机器人解剖性肺段切除术,其中40例肺段切除术和7例肺亚段切除术;手术中解剖观察与术前CT三维重建对比,患者肺血管、支气管位置及分支的显示均吻合,手术均顺利完成,无中转开胸。手术时间(129.68±43.14)min,术中出血(104.36±76.31)mL,术后胸腔引流量(748.30±444.63)mL,术后拔管时间(2.89±1.73)d,术后住院时间(4.38±1.78)d,术后并发症发生率为8.5%(4/47)。术后病理结果显示:恶性肿瘤42例,良性病变5例。42例恶性肿瘤患者切缘均为阴性,淋巴结清扫个数为(7.29±5.62)枚,淋巴结清扫站数为(5.09±1.75)站。术后随访3个月,无一例患者肿瘤复发或死亡。结论CT三维重建辅助达芬奇机器人解剖性肺段切除术是安全有效的。Objective To investigate the feasibility and clinical outcome of(three-dimensional)3D reconstruction techniques for robotic-assisted anatomical segmentectomy.Methods This research is a retrospective study of 47 patients(16 males and 31 females),aged(53.15±12.19)years,who underwent chest computed tomography(CT)3D reconstruction and robotic-assisted segmentectomy in the Department of Thoracic Surgery,Ruijin Hospital,Shanghai Jiaotong University from May 2017 to September 2018.All the patients were reconstructed in 3D in accordance with their CT image data of the chest before surgery.The maximum diameter of pulmonary nodules was(8.04±2.96)mm.The surgeon performed an anatomical segmentectomy on the basis of the reconstructed image.We collected and analyzed perioperative data.Results Preoperative 3D reconstruction accurately showed the location of pulmonary nodules and the boundaries,and the surrounding structures'relationship like the pulmonary arteries,veins and bronchus were clearly observed.All 3D reconstruction robotic-assisted anatomical segmentectomies were designed and successfully completed without transposition.A total of 40 patients underwent segmentectomy,and 7 patients underwent subsegmentectomy.The position and grade of pulmonary vessels and bronchi were observed via anatomical observation and 3D CT reconstruction.The operation time was(129.68±43.14)min.Intraoperative bleeding was(104.36±76.31)mL.Postoperative chest volume was(748.30±444.63)mL.Postoperative extubation time was(2.89±1.73)days.Postoperative hospital stay was(4.38±1.78)days.Postoperative complications were 8.5%(4/47).Postoperative pathological results showed that 42 patients had malignant tumors and 5 patients had benign lesions.All 42 patients had a negative surgical margin.The number of lymph node dissection was 7.29±5.62,and the number of lymph node dissection stations was 5.09±1.75.None of the patients experienced tumor recurrence or died after 3 months of follow-up.Conclusions Robotic-assisted segmentectomy based on preoperati

关 键 词：肺肿瘤 肺结节 体层摄影术 X线计算机 肺段切除术 机器人手术 三维重建 

分 类 号：R734.2[医药卫生—肿瘤]