三维影像重建技术在腹腔镜下肾部分切除术中的临床价值研究  

Study of the applied effect of 3D image reconstruction in laparoscopic partial nephrectomy

作　　者：陈钶杰 林繁录 徐英民 Chen Kejie;Lin Fanlu;Xu Yingmin(School of Clinical Medicine,Shandong Second Medical University,Weifang 261000,China;Department of Urinary Surgery,Linyi Central Hospital,Linyi 276400,China)

机构地区：[1]山东第二医科大学临床医学院,潍坊261000 [2]临沂市中心医院泌尿外科,临沂276400

出　　处：《中国医学装备》2025年第2期47-53,共7页China Medical Equipment

基　　金：山东省医药卫生科技发展计划(202102080340)。

摘　　要：目的:探讨三维影像重建技术在腹腔镜下肾部分切除术(LPN)中的临床价值。方法:回顾性选取2019年5月至2022年12月在临沂市中心医院因肾肿瘤行LPN的80例患者,依据术前影像学检查方式的不同将其分为观察组和对照组,每组40例。观察组经CT尿路造影(CTU)检查后将所得的DICOM数据经三维影像重建系统重建三维影像,通过三维模型辅助手术方案规划和术中定位,并借助三维影像模型告知患者家属病情,观察肿瘤大小、位置以及肿瘤与血管及周围组织器官的关系,行腹腔镜下肾部分切除术。对照组经CTU检查后借助CT图像辅助腹腔镜肾部分切除术。比较两组围术期各项临床指标的差异,检测两组患者术前、术后和随访时的血肌酐值,通过问卷调查的方法对患者家属告知的内容项目理解程度进行评分。结果:观察组和对照组患者在性别、年龄、肿瘤侧别、肿瘤最大直径、体质指数、肾肿瘤评分系统[最大径(R)、外凸率(E)、最近距离(N)、侧别(A)、纵向位置(L)]评分和术前血肌酐水平等一般资料比较,差异无统计学意(P>0.05)。观察组肾动脉阻断时间(21.70±6.39)min、寻找目标动脉时间(9.25±2.95)min、手术时间(122.55±42.57)min以及肿瘤切除时间(6.47±2.25)min均短于对照组,差异有统计学意义(t=-2.87、-4.49、-3.60、-3.41,P<0.05)。观察组患者家属对肾脏构造的理解程度、肿瘤部位及大小的理解程度、肿瘤与周围组织关系的理解程度和手术方案及目的的理解程度评分均高于对照组,两组比较差异均有统计学意义(t=-10.07、-13.86、-2.97、-17.57、-17.12,P<0.05)。观察组患者术中出血量、术后住院天数、切缘阳性率、并发症发生率和术后随访血肌酐水平比较差异无统计学意义(P>0.05)。结论:三维影像重建技术辅助腹腔镜下肾部分切除术,能够缩短手术时间、肾动脉阻断时间、肿瘤切除时间和寻找目标动脉时Objective:To explore the applied value of three-dimensional(3D)image reconstruction in laparoscopic partial nephrectomy(LPN).Methods:A total of 80 patients who underwent LPN due to renal tumors at Linyi Central Hospital between May 2019 and December 2022 were retrospectively selected.The patients were divided into an observation group and a control group,with 40 cases in each group,according to different preoperative imaging examination methods.After computed tomography urography(CTU)examination,the obtained DICOM data of observation group were used to reconstruct 3D images by 3D image reconstruction system.The planning and intraoperative positioning were conducted through auxiliary surgery plan with 3D model,and patients’conditions were informed to their family members through 3D image model.The size and location of the tumor,and the relationship between the tumor,blood vessels and surrounding tissues and organs were observed.Then,the LPN was performed.The control group used CT images to assist LPN after CTU examination.The differences in variously perioperative clinical indicators between the two groups were compared.Blood creatinine levels of two groups were measured before,after,and during follow-up.Additionally,a questionnaire survey was used to score the understanding level of patients’families for the informed content items.Results:There were no significant differences between the two groups in gender,age,difference of tumor side,maximum tumor diameter,body mass index,the score of R.E.N.A.L score system of renal tumor[maximum diameter(R),external convexity rate(E),the closest distance(N),difference of side(A)and longitudinal position(L)],preoperative serum creatinine,and other general data(P>0.05).The occlusion time(21.70±6.39)min of renal artery,the time(9.25±2.95)min of seeking target artery,the operation time(122.55±42.57)min,and the resection time(6.47±2.25)min of tumor in the observation group were all shorter than those in the control group,and the differences of them between two groups were

关 键 词：三维影像重建技术 腹腔镜 肾肿瘤 肾部分切除术 

分 类 号：R699.2[医药卫生—泌尿科学]