虚拟膀胱镜技术在非肌层浸润性膀胱癌手术分型中的初步应用  

Application of virtual cystoscopy based on ultra-thin slice thickness multi-parameter magneticresonance imaging in surgical classification of non-muscle invasive bladder cancer

作　　者：夏启东 孟晓岩[2] 胡恒龙 宋文 胡嘏 李凡[1] 叶章群[1] 李震[2] 王少刚[1] 刘征 XIA Qidong;MENG Xiaoyan;HU Henglong;SONG Wen;HU Jia;LI Fan;YE Zhangqun;LI Zhen;WANG Shaogang;LIU Zheng(Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [2]华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《现代泌尿生殖肿瘤杂志》2024年第3期144-148,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的浅探基于超薄磁共振灌注成像三维重建的虚拟膀胱镜检查在非肌层浸润性膀胱癌(NMIBC)患者手术分型中应用的可行性。方法回顾性分析2020年7月至8月收治的3例NMIBC患者的资料。术前均行超薄磁共振灌注成像,在获得患者知情同意后采集检查数据,使用3D交互式医学影像控制系统Mimics对影像进行三维重建构建高精度的虚拟膀胱镜模型,在术前用于激光切除术的手术规划。结果3例手术均顺利完成,手术时间分别为20、55、60 min。术后病理报告切缘均为阴性,围手术期3例患者均无Clavien-DindoⅡ级及以上的并发症。术后2~7d恢复出院,其中1例为高级别尿路上皮癌,术后1个月定期行卡介苗灌注治疗,另外2例均为低危NMIBC,术后定期行吉西他滨或沙培林维持灌注,定期随访至今,3例患者均无复发。结论基于超薄磁共振灌注成像的高精度虚拟膀胱镜技术对于NMIBC患者的激光切除术前预分割、减少手术时间有临床辅助意义,同时有待未来进行前瞻性队列研究来明确术前虚拟膀胱镜技术的应用是否有助于降低NMIBC患者的术后复发率。Objective To explore the value of three-dimensional reconstruction based on ultrathin slice thickness multi-parameter magnetic resonance imaging as a preoperative virtual cystoscopy in the surgery management of patients with non-muscle invasive bladder cancer.Methods The medical records and corresponding basic characteristics of three patients with non-muscle invasive bladder cancer from July to August 2020 were collected retrospectively.All patients underwent ultrathin magnetic resonance perfusion imaging before surgery.After the patient's informed consent was obtained,the examination data were collected.The 3D interactive medical image control system Mimics was used to reconstruct the image,and a high-precision virtual cystoscopy model was applied to the preoperative planning for en-bloc operation.Results All the 3 operations were completed successfully,and the operation time were 20,55,and 60 minutes,respectively.Besides,the postoperative pathological reports showed that the incisal margin was negative,and there were no complications of Clavien-DindoⅡgrade or above in all 3 patients during the perioperative period.All these 3 patients were discharged from hospital within 2-7 days after operation.One case was highgrade urothelial cancer and regularly received intravesical BCG instillation one month after operation.The other two cases were low-risk non-muscle invasive bladder cancer and regularly received intravesical gemcitabine or shapelin instillation after operation.So far,there was no recurrence in all three patients under regular follow-up.Conclusions High precision virtual cystoscopy based on ultra-thin magnetic resonance perfusion imaging has some clinical significance in pre-segmentation and reducing operative time in patients with non-muscle invasive bladder cancer.However,there needs more prospective cohort studies to explore whether the application of high precision virtual cystoscopy contributes to reducing the post-surgery recurrence rate in patients with non-muscle invasive bladder cancer.

关 键 词：虚拟膀胱镜 非肌层浸润性膀胱癌 多参数磁共振 激光切除术 并发症 

分 类 号：R737.14[医药卫生—肿瘤]