全息影像腹腔镜融合技术在肾内型肿瘤切除术中的应用  

Application of holographic image fusion technique in laparoscopic partial nephrectomy of intrarenal tumor

作　　者：赵子臣[1] 朱鹤[1] 王刚[1] 翁国斌 朱伟智 高平生[3] 李宁忱[1] 那彦群[1] ZHAO Zichen;ZHU He;WANG Gang;WENG Guobin;ZHU Weizhi;GAO Pingsheng;LI Ningchen;NA Yanqun(Peking University Shougang Hospital,Peking University Wujieping Urology Center,Beijing,100144,China;Department of Urology,Ningbo Yinzhou No.2 Hospital;Department of Urology,People's Hospital of Ningxia Hui Autonomous Region)

机构地区：[1]北京大学首钢医院北京大学吴阶平泌尿外科医学中心,北京100144 [2]宁波市鄞州第二医院泌尿外科 [3]宁夏回族自治区人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2020年第7期528-531,538,共5页Journal of Clinical Urology

摘　　要：目的:探索全息影像用于腹腔镜手术术中定位病变以及辅助手术医生决策的方法、可行性和准确性。方法:选取5例因肾内型肿瘤行腹腔镜肾部分切除术的患者,术前将患者肾脏增强CT数据导出并进行全息影像的重建和分析,将重建后的影像导入全息影像腹腔镜手术融合平台中。结果:患者A腹腔镜手术中,肉眼初步确定可疑的肿瘤位置,使用术中超声验证肿瘤位置;随后将重建影像与腹腔镜影像校准融合后,重建影像中的肿瘤位置与肉眼及超声所见病变位置一致。患者B、D术中先用重建影像定位病变所在位置,随后使用术中超声探查见病变位置与先前定位一致。患者C的术中校准融合重建影像后,重建影像中病变位置与肉眼所见位置一致。在患者E的手术中通过该平台进行远程调节和校准重建影像,实现了基于该平台的术中实时远程会诊。以上5例手术均在腹腔镜下完成,未出现并发症,术后病理肿瘤切除完整,外科切缘均阴性。结论:基于CT影像的全息影像腹腔镜融合技术,可用于术中深部病变的寻找和定位,该影像所提示的肿瘤位置,与肉眼及术中超声所定位的位置吻合。该技术可在腹腔镜手术中增强术者对于病变位置和周围毗邻的认知,并为术者进行决策提供直观的参考。Objective: To explore the methodology, feasibility and accuracy of holographic imaging for locating lesions in laparoscopic surgery and assisting surgeons in decision-making. Method: Five patients who underwent laparoscopic partial nephrectomy for intrarenal tumors were selected. The patients’ renal enhancement CT data were exported and reconstructed into holographic images, then analyzed and adjusted by surgeons upon their needs. The reconstructed images were imported into a holographic image laparoscopic surgery fusion platform. Result: In patient A’s surgery, the tumor was located by naked eyes first and then confirmed by laparoscopic intraoperative ultrasound. After the reconstructed image was fused with the laparoscopic image, the position of the tumor in the reconstructed image was consistent with that of the naked eye and the ultrasound. In patient B and D’s case, the reconstructed image was used to locate the lesion first and then intraoperative ultrasound found that the lesion was consistent with the previous location. Patient C’s tumor was located by reconstructed image, the position of the lesion in the reconstructed image was consistent with that seen by the naked eye. Remote calibration and control of the reconstructed image were performed through this platform during the operation of the Patient E, which created a novel modality of intraoperative real-time remote consultation. All the above five operations were performed under laparoscopy, no complications occurred, and the pathology showed all tumors were completely resected and the surgical margins were negative. Conclusion: The holographic image fusion technology based on CT image can be used for spotting and locating deep lesions in laparoscopic surgery. The position of the tumor indicated by the image is consistent with the location of the naked eye and intraoperative ultrasound. This technique can enhance the surgeon’s perception of the location of the lesion and its adjacent tissue in laparoscopic surgery, and provide intuitive refe

关 键 词：全息影像 腹腔镜肾部分切除术 肾脏肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]