Li Guan, Cao Zhiqiang, Wang Jinbao, Zhang Xin, Zhang Longjiang, Dong Jie, Lu Guangming
Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Urology, General Hospital of Northern Theater Command, Shenyang, China.
Quant Imaging Med Surg. 2021 Jun;11(6):2658-2668. doi: 10.21037/qims-20-956.
Nephron-sparing surgery has been widely applied in the treatment of renal tumors. Previous studies have confirmed the advantages of mixed reality technology in surgery. The study aimed to explore the optimization of mixed reality technology and its application value in nephron-sparing surgery.
In this prospective study of 150 patients with complex renal tumors (RENAL nephrometry score ≥7) who underwent nephron-sparing surgery, patients were randomly divided into Group A (the normal-dose mixed reality group, n=50), Group B (the low-dose mixed reality group, n=50), and Group C (the traditional computed tomography image group, n=50). Group A and Group C received the normal-dose computed tomography scan protocol: 120 kVp, 400 mA, and 350 mgI/mL, while Group B received the low-dose computed tomography scan protocol: 80 kVp, automatic tube current modulation, and 320 mgI/mL. All computed tomography data were transmitted to a three-dimensional visualization workstation and underwent modeling and mixed reality imaging. Two senior surgeons evaluated mixed reality quality. Objective indexes and perioperative indexes were calculated and compared.
Compared with Group A, the radiation effective dose in Group B was decreased by 39.6%. The subjective scores of mixed reality quality in Group B were significantly higher than those of Group A (Z=-4.186, P<0.001). The inter-observer agreement between the two senior surgeons in mixed reality quality was excellent (K=0.840, P<0.001). The perioperative indexes showed that the mixed reality groups were significantly different from the computed tomography image group (all P<0.017). More cases underwent nephron-sparing surgery in the mixed reality groups than in the computed tomography image group (P<0.0017).
Low-dose computed tomography technology can be effectively applied to mixed reality optimization, reducing the effective dose and improving mixed reality quality. Optimized mixed reality can significantly increase the cases of successful nephron-sparing surgery and improve perioperative indexes.
保留肾单位手术已广泛应用于肾肿瘤的治疗。既往研究已证实混合现实技术在手术中的优势。本研究旨在探讨混合现实技术的优化及其在保留肾单位手术中的应用价值。
在这项对150例接受保留肾单位手术的复杂性肾肿瘤（RENAL肾计量评分≥7）患者的前瞻性研究中，患者被随机分为A组（常规剂量混合现实组，n = 50）、B组（低剂量混合现实组，n = 50）和C组（传统计算机断层扫描图像组，n = 50）。A组和C组接受常规剂量计算机断层扫描方案：120 kVp、400 mA和350 mgI/mL，而B组接受低剂量计算机断层扫描方案：80 kVp、自动管电流调制和320 mgI/mL。所有计算机断层扫描数据均传输至三维可视化工作站并进行建模和混合现实成像。两名资深外科医生评估混合现实质量。计算并比较客观指标和围手术期指标。
与A组相比，B组的辐射有效剂量降低了39.6%。B组混合现实质量的主观评分显著高于A组（Z = -4.186，P < 0.001）。两名资深外科医生在混合现实质量方面的观察者间一致性极佳（K = 0.840，P < 0.001）。围手术期指标显示，混合现实组与计算机断层扫描图像组有显著差异（所有P < 0.017）。混合现实组接受保留肾单位手术的病例数多于计算机断层扫描图像组（P < 0.0017）。
低剂量计算机断层扫描技术可有效应用于混合现实优化，降低有效剂量并提高混合现实质量。优化后的混合现实可显著增加保留肾单位手术成功的病例数并改善围手术期指标。
