实影渲染重建技术辅助腹腔镜巨大肾上腺肿瘤切除术的应用研究  

The use of cinematic rendering technology to assist laparoscopic resection of giant adrenal tumors

作　　者：唐家润 徐斌 周永霞[3] 卿菁 胡科 陈江川[1] 许巧 何云锋[4] 张家模[1] Tang Jiarun;Xu Bin;Zhou Yongxia;Qing Jing;Hu Ke;Chen Jiangchuan;Xu Qiao;He Yunfeng;Zhang Jiamo(Department of Urology,Yongchuan Hospital,Chongqing Medical University,Chongqing 402160,China;Department of Urology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400020,China;Department of Radiology,Yongchuan Hospital,Chongqing Medical University,Chongqing 402160,China;Department of Urology,First Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属永川医院泌尿外科,重庆402160 [2]重庆市中医院泌尿外科,重庆400020 [3]重庆医科大学附属永川医院放射科,重庆402160 [4]重庆医科大学附属第一医院泌尿外科,重庆400010

出　　处：《中华泌尿外科杂志》2025年第2期81-86,共6页Chinese Journal of Urology

基　　金：重庆市科卫联合项目(2022MSXM108);重庆市创新医疗器械应用示范项目(渝经信2024-22);重庆市永川区自然科学基金资助项目(2022yc-jckx20054)。

摘　　要：目的探讨实影渲染重建技术在腹腔镜肾上腺巨大肿瘤切除术中的应用价值。方法回顾性分析2021年1月至2024年1月重庆医科大学附属永川医院收治的21例巨大肾上腺肿瘤患者的病例资料,男11例,女10例。中位年龄54.0(40.5,58.0)岁。肿瘤中位直径7.3(6.8,8.8)cm。所有患者术前均行增强CT扫描,将CT图像用后处理工作站平台进行三维重建,通过变换图像视角,以及增加或减低各脏器、血管的显像,并且基于物理的体绘制进行实影渲染三维重建成像,获得实影渲染图像。通过实影渲染三维重建图像,术者术前可直观了解肿瘤与周围脏器的关系,以及肿瘤供养血管的走行等重要信息,并进行术前规划。术前充分准备后,所有患者均接受经腹腹腔镜肾上腺肿瘤切除术。术中观察结果与术前实影渲染三维成像一致,20例肿瘤位于肾上腺,1例位于腹膜后;肿瘤位于左侧13例,右侧8例。结果本组21例手术均顺利完成,手术时间(199.0±95.3)min,中位出血量220(150,500)ml,中位输血量200(150,400)ml,无重要脏器及大血管等损伤,无中转开放手术病例。结论对于腹膜后巨大肾上腺肿瘤,术前通过实影渲染三维重建成像充分了解肿瘤与周围脏器、血管的关系,可避免术中出血和副损伤。Objective To explore the application value of cinematic rendering reconstruction technology in laparoscopic resection of giant adrenal tumors.Methods As many as 21 patients with large adrenal tumors who underwent laparoscopic resection in Yongchuan Hospital Affiliated to Chongqing Medical University from January 2021 to January 2024 were retrospectively analyzed,with a median age of 54.0(40.5,58.0)years and a median tumor diameter of 7.3(6.8,8.8)cm.All patients underwent preoperative cinematic rendering 3D reconstruction imaging.All patients underwent enhanced CT scans.Their CT images were three-dimensionally reconstructed on the post-processing workstation platform.By changing image perspectives,adjusting the visualization of organs or blood vessels,and using physical volume rendering,real-shadow-rendered images were obtained.With these images,surgeons can intuitively understand important preoperative information,like the relationship between the tumor and surrounding organs and the path of tumor-feeding blood vessels,for preoperative planning.Following thorough preoperative preparation,laparoscopic transabdominal resection was performed.During surgery,20 tumors were found to be located in the adrenal gland,and 1 in the retroperitoneum,with 13 on the left side and 8 on the right side.Preoperative cinematic rendering 3D imaging was consistent with intraoperative findings.Results All 21 patients underwent successful surgeries,with an average operation time of(199.0±95.3)minutes,a median blood loss of 220(150,500)ml,and a median blood transfusion volume of 200(150,400)ml.No significant damage of vital organs or major blood vessels occurred,and there were no case of conversion to open surgery.Conclusions For retroperitoneal giant adrenal tumors,utilizing cinematic rendering 3D reconstruction imaging enables a comprehensive understanding of the relationship between the tumor and surrounding organs and vessels preoperatively.This approach can reduce intraoperative bleeding and collateral injuries,improve the success

关 键 词：肾上腺肿瘤 实影渲染技术 腹腔镜 CT 

分 类 号：R73[医药卫生—肿瘤]