三维可视化技术在腹腔镜结直肠癌D3根治术中应用价值  

Clinical significance of three-dimensional visualization technology for the laparoscopic D3 radical resection of colorectal cancer

作　　者：陈建新[1] 沈海平 袁燕文 李伊敏 李新[3] 宋睿 唐煜欣 彭伟谦 王毅钧 李力波[1] 李瑞平[1] CHEN Jianxin;SHEN Haiping;YUAN Yanwen;LI Yimin;LI Xin;SONG Rui;TANG Yuxin;PENG Weiqian;WANG Yijun;LI Libo;LI Ruiping(Department of Gastrointestinal Surgery,the Affiliated Dongguan Municipal People′s Hospital,Southern Medical University,Dongguan 523059,China;不详)

机构地区：[1]南方医科大学附属东莞医院胃肠外科,广东东莞523059 [2]南方医科大学附属东莞医院放射科,广东东莞523059 [3]南方医科大学附属东莞医院消化内科,广东东莞523059

出　　处：《实用医学杂志》2022年第12期1533-1540,共8页The Journal of Practical Medicine

基　　金：东莞市社会科技发展(重点)项目(编号:201950715001169)。

摘　　要：目的初步探索三维可视化技术对结直肠癌患者施行腹腔镜D3根治术的临床应用价值。方法回顾分析2019年5月至2021年3月在东莞市人民医院接受腹腔镜结直肠癌D3根治术的40例患者的临床资料,患者术前均行薄层增强CT检查后运用商业重建软件进行三维可视化重建并指导实际手术。结果三维可视化重建模型清晰显示结肠形态和走向、肿瘤位置、各主要血管以及癌肿供血血管解剖与变异,与实际手术探查符合率100%,根据三维模型术前拟定的结直肠癌D3根治术手术方案与实际手术方案符合率100%。全组40例患者均顺利完成手术,无1例患者中转开腹手术。血管意外损伤数目为0,手术时间(162.1±51.7)min,术中失血量(58.6±46.3)mL;术后首次排气时间(51.7±36.7)h,术后住院时间(8.2±6.5)d。术后出现并发症者4例,其中炎性肠梗阻1例,吻合口漏1例,淋巴漏2例,并发症发生率为10.0%,所有并发症均保守治疗治愈出院,无术中及术后死亡病例。术后病理结果显示:肿瘤直径(5.1±3.8)cm,淋巴结(包含系膜内癌结节)清扫数目(28.8±39.1)枚,其中阳性淋巴结数目(3.9±2.5)枚;肿瘤分期:Ⅰ期4例,Ⅱa期8例,Ⅱb期5例,Ⅲa期15例,Ⅲb期5例,Ⅲc期3例。结论三维可视化技术在明确肿瘤供血动脉及其血管变异基础上,不但能提高手术效率和安全性,更能在符合肿瘤学基础上施行精准的腹腔镜结直肠癌D3根治术。Objective To preliminary explore the clinical value of three-dimensional visualization technology for the laparoscopic D3 radical resection of colorectal cancer.Methods The clinical data of forty patients with colorectal cancer undergoing laparoscopic D3 radical operation in Dongguan Municipal People′s Hospital from May2019 to December March 2021 were analyzed retrospectively.Before the operation,all patients underwent enhanced CT examination and then used commercial reconstruction software to perform 3D visualization reconstruction and guide the actual operation.Results The three-dimensional visualization model clearly showed the shape and direction of the colon,the location of the tumor,the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer,and showing a coincidence rate of 100%with the actual surgical exploration.The D3radical resection of colorectal cancer is formulated based on the three-dimensional model before the operation.The coincidence rate with the actual surgical plan was 100%.All the 40 patients completed operations successfully,and no patient was converted to open surgery.The unexpected injury of blood vessel did not happen.The mean operative time was(162.1±51.7)min with a mean estimated blood loss of(58.6±46.3)m L.The mean time of first flatus was(51.7±36.7)h and the postoperative hospital stay was(8.2±6.5)d.The postoperative complications appeared in 4 patients,including one of inflammatory bowel obstruction,one of anastomotic leakage and two of lymphatic fistula,the complication rate was 10.0%,and they were all cured with conservative treatments.The mean number of harvested lymph node was(28.8±39.1),among which(3.9±2.5)was positive.TNM staging:StageⅠ4 cases,StageⅡa 8 cases,StageⅡb 5 cases,StageⅢa 15 cases,StageⅢb 5 cases,StageⅢc 3 cases.Conclusions On the basis of clarifying tumor blood supply arteries and their vascular variations,3D visualization technology can not only improve the efficiency and safety of surgery,but also perform acc

关 键 词：三维可视化技术 腹腔镜 结直肠癌 D3根治术 

分 类 号：R735.34[医药卫生—肿瘤]