三维影像重建技术在腹腔镜精准胰腺肿瘤手术应用研究  

Research and application of laparoscopic precision pancreatic cancer surgery based on 3D image reconstruction

作　　者：吴峥嵘[1] 陈文超 陈炯煌[1] 曹利平[1] WU Zheng rong;CHEN Wen-chao;CHEN Jiong huang;CAO Li-ping(Department of General Surgery,Sir Run Run Shaw Hospital,Zhejiang Univrsity School of Medicine,Hangzhou 310020,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,浙江杭州310020

出　　处：《中华肿瘤防治杂志》2021年第15期1170-1174,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：浙江省重大科技专项重点社会发展项目(2015C03036)。

摘　　要：目的探讨三维重建在腹腔镜胰腺肿瘤切除应用中的临床价值。方法选取2017-01-01-2018-11-01在浙江大学医学院附属邵逸夫医院普外科就诊的胰腺肿瘤患者204例,按照是否进行术前三维重建分为研究组(102例)和对照组(102例)。分析2组间手术时间、术中出血量、淋巴结清除数量、R0切除率及患者病情了解程度的差异。2组间R0切除率及了解程度变量的差异比较采用χ^(2)检验。淋巴结数量及术中出血量采用Shapiro-Wilk(S-W)方法进行正态分布检验后采用t检验或Mann-Whitney U检验。结果研究组中61例患者和对照组中56例患者进行腹腔镜胰十二指肠切除术,研究组患者的R0切除率(χ^(2)=5.966,P=0.025)及淋巴结清除数量明显提高(t=0.981,P=0.011),手术时间(t=10.321,P<0.001)及术中出血量(t=12.325,P=0.004)均显著降低。在腹腔镜胰体尾切除术中,研究组中41例患者和对照组中46例患者在R0切除率(χ^(2)=0.478,P=0.478)、淋巴结清除数量(t=0.981,P=0.464)、手术时间(t=10.321,P=0.541)及术中出血量(t=12.325,P=0.462)方面差异均无统计学意义。文化程度2组比较差异无统计学意义,χ^(2)=0.540,P=0.462。对病情了解程度2组比较差异有统计学意义,χ^(2)=14.77,P<0.010。该结果显示,三维重建可增加对患者疾病的了解程度。结论术前三维重建在胰腺癌行腹腔镜胰十二指肠切除术时,明显提高患者的R0切除率及淋巴结清除数量,显著降低手术时间及术中出血量,并增加患者对疾病的了解程度。该技术有助于腹腔镜胰腺肿瘤切除术中肿瘤定位。Objective To evaluate the clinical value of three-dimensional reconstruction in the application of laparoscopic pancreatic tumor resection by analyzing the clinical data of patients with pancreatic cancers.Methods A total of 204 patients with pancreatic cancer were collected and divided into the study group and the control group according to whether preoperative three-dimensional reconstruction was performed.The differences in operation time, intraoperative blood loss, number of lymph nodes removed, R0 resection rate, and degree in the understanding of the patient’s condition between the two groups were analyzed.The difference of R0 resection rate and degree of understanding variables between the two groups was compared by using Chi-square test.The operation time, number of lymph nodes and intraoperative blood loss of the two groups were tested by using the Shapiro-Wilk(S-W) method for normal distribution and then using the t test or Mann-Whitney U test.Results Totally 61 patients in the study group and 56 patients in the control group underwent laparoscopic pancreatoduodenectomy.The R0 resection rate(χ2=5.966,P=0.025) and the number of lymph nodes cleared in the study group were significantly increased(t=0.981,P=0.011),operation time(t=10.321,P<0.001) and intraoperative blood loss(t=12.325,P=0.004) were significantly reduced.Totally 41 patients in the study group and 46 patients in the control group underwent pancreatectomy, the R0 resection rate(χ2=0.478,P=0.478) and lymph node clearance(t=0.981,P=0.464),operation time(t=10.321,P=0.541) and intraoperative blood loss(t=12.325,P=0.462) in two groups were not statistically different.Compared with the control group, there was no statistically significant difference in the educational level of the assessed patients(χ2=0.540,P=0.462).Compared to the control group, the understanding of the patient’s condition in the study group has been improved,and the difference is statistically significant(χ2=14.77,P<0.010),indicating that three-dimensional reconstruction c

关 键 词：胰腺肿瘤 三维成像 腹腔镜手术 胰十二指肠切除术 胰体尾切除术 

分 类 号：R735.9[医药卫生—肿瘤]