立体定向数字导航系统辅助3D腹腔镜直肠癌全直肠系膜切除术的应用价值  

Application value of stereotactic digital navigation system assisted three-dimensional laparoscopic total mesorectal excision for rectal cancer

作　　者：杜广胜 李云波 刘云 彭菊红 江恩来 殷久恒 徐鹏 肖卫东 Du Guangsheng;Li Yunbo;Liu Yun;Peng Juhong;Jiang Enlai;Yin Jiuheng;Xu Peng;Xiao Weidong(Department of General Surgery,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Radiology,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Neurosurgery,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院普通外科,重庆400037 [2]陆军军医大学第二附属医院放射科,重庆400037 [3]陆军军医大学第二附属医院神经外科,重庆400037

出　　处：《中华消化外科杂志》2022年第3期408-414,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81770524)。

摘　　要：目的探索立体定向数字导航(SDN)系统辅助3D腹腔镜直肠癌全直肠系膜切除术的应用价值。方法采用回顾性描述性研究方法。收集2021年5―9月陆军军医大学第二附属医院招募1例健康志愿者的临床资料和收治3例行SDN系统辅助3D腹腔镜直肠癌全直肠系膜切除术患者的临床病理资料。志愿者男,25岁。3例直肠癌患者中男2例,女1例;年龄分别为48、63、67岁。志愿者双侧腹股沟部的髂前上棘、耻骨结节、耻骨联合处分别放置10个专用贴片作为皮肤基准点,进行术中定位及系统注册。手术当日,患者在平卧位状态按志愿者测试结果在腹股沟部放置10个皮肤基准点,完成全腹部CT检查增强扫描。在腹腔内部选取7个相对固定的解剖标志(腹主动脉分叉、骶骨胛、双侧髂前上棘、双侧输尿管与髂动脉交叉点、腹膜反折正中点)分别验证器械尖端与系统图像对应的精准度。在SDN系统辅助下完成3D腹腔镜直肠癌全直肠系膜切除术。观察指标:(1)测试情况。(2)手术情况。(3)SDN系统精准度检测情况。正态分布的计量资料以x±s表示。结果(1)测试情况:志愿者10个皮肤基准点成功完成SDN系统注册,配准误差为2.8 mm。(2)手术情况:3例患者均顺利完成SDN系统辅助3D腹腔镜直肠癌全直肠系膜切除术。3例患者手术总时间分别为193、175、210 min,其中SDN系统设置时间分别为34、25、45 min;术中出血量分别为60、30、80 mL。3例患者术后病理学检查结果均为腺癌(其中1例为黏液腺癌),肿瘤长径分别为2.3、1.5、4.0 cm,淋巴结清扫数目分别为12、12、13枚,均无淋巴结转移;术前临床分期(cTNM分期)分别为cT3bN0M0期、cT4aN1M0期、cT3bN1M0期的患者新辅助治疗后分期(ypTNM分期)分别为ypT1N0M0期、ypT4aN0M0期、ypT2N0M0期。患者术后均无并发症发生,术后住院时间分别为7、6、7 d。(3)SDN系统精准度检测情况:3例患者皮肤基点配准误差�Objective To investigate the application value of stereotactic digital navigation system assisted three-dimensional(3D)laparoscopic total mesorectal excision(TME)for rectal cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of a healthy volunteer recruited by the Second Affiliated Hospital of Army Medical University and 3 patients who underwent stereotactic digital navigation system assisted 3D laparoscopic TME for rectal cancer in the Second Affiliated Hospital of Army Medical University from May to September 2019 were collected.The healthy volunteer was male,aged 25 years.Of the 3 rectal cancer patients,there were 2 males and 1 female,with the age of 48 years,63 years and 67 years,respectively.Ten special patches were placed at the anterior superior iliac spine,pubic tubercle and pubic symphysis of the volunteer's bilateral inguen as skin reference points in intraoperative localization and system registration.On the day of operation,patients were placed 10 special patches as skin reference points according to the test results of the volunteer and were completed the enhanced scan of totally abdominal computed tomography examination.Seven fixed anatomical markers in the abdominal cavity of the patients,including abdominal aortic bifurcation,sacrum scapula,bilateral anterior superior iliac spine,bilateral intersection of ureter and iliac artery and median point of peritoneal reflection,were selected for verifying the accuracy of the correspondence between the instrument tip and the system image.Patients underwent 3D laparoscopic TME for rectal cancer assisted by stereotactic digital navigation system.Observation indicators:(1)test results;(2)surgical situations;(3)accuracy of stereotactic digital navigation system.Measurement data with normal distribution were represented as Mean±SD.Results(1)Test results.The 10 skin reference points of the volunteer were successfully registered in the stereotactic digital navigation system,with the registration error of 2.8 mm.(2)Su

关 键 词：直肠肿瘤 立体定向数字导航 全直肠系膜切除术 增强现实 腹腔镜检查 

分 类 号：R735.37[医药卫生—肿瘤]