三维可视化技术在腹腔镜右半结肠癌D3根治性切除术中的应用
[Application of three-dimensional visualization technique in laparoscopic D3 radical resection of right colon cancer].
作者信息
Chen J, Yuan Y, Peng W, Tang Y, Chen X, Wang Y, Shen H, Li R
机构信息
Department of Gastrointestinal Surgery, Dongguan People's Hospital Affiliated to Southern Medical University, Dongguan 523059, China.
Department of Gastroenterology, Dongguan People's Hospital Affiliated to Southern Medical University, Dongguan 523059, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2022 May 20;42(5):760-765. doi: 10.12122/j.issn.1673-4254.2022.05.19.
OBJECTIVE
To explore the clinical value of three-dimensional (3D) visualization technique in laparoscopic D3 radical resection of right colon cancer.
METHODS
We retrospectively analyzed the clinical data of 73 patients with right colon cancer undergoing laparoscopic D3 radical operation in our hospital between May, 2019 and March, 2021. Among these patients, 41 underwent enhanced CT examination with 3D visualization reconstruction to guide the actual operation, and 32 underwent enhanced CT examination only before the operation (control group). In 3D visualization group, we examined the coincidence rate between the 3D visualization model and the findings in surgical exploration of the anatomy and variations of the main blood vessels, supplying vessels of the tumor, and the tumor location, and the coincidence rate between the actual surgical plan for D3 radical resection of right colon cancer and the plan formulated based on the 3D model. The operative time, estimated blood loss, unexpected injury of blood vessels, number of harvested lymph nodes, mean time of the first flatus, complications, postoperative hospital stay and postoperative drainage volume were compared between the two groups.
RESULTS
The operative time was significantly shorter in 3D visualization group than in the control group ( < 0.05). The volume of blood loss, proportion of unexpected injury of blood vessel, the number of harvested lymph nodes, time of the first flatus, proportion of complications, postoperative hospital stay and postoperative drainage volume did not differ significantly between the two groups ( > 0.05). In the 3D visualization group, the 3D visualization model clearly displayed 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 showed a coincidence rate of 100% with the findings by surgical exploration. The surgical plan for D3 radical resection of right colon cancer was formulated based on the 3D model also showed a coincidence rate of 100% with the actual surgical plan.
CONCLUSION
The 3D visualization reconstruction technique allows clear visualization the supplying arteries of the tumor and their variations to improve the efficiency, safety and accuracy of laparoscopic D3 radical resection of right colon cancer.
目的
探讨三维（3D）可视化技术在腹腔镜右半结肠癌D3根治性切除术中的临床应用价值。
方法
回顾性分析2019年5月至2021年3月在我院行腹腔镜D3根治性手术的73例右半结肠癌患者的临床资料。其中41例行增强CT检查并行3D可视化重建以指导实际手术，32例仅在术前进行增强CT检查（对照组）。在3D可视化组中，观察3D可视化模型与手术探查中主要血管、肿瘤供血血管的解剖及变异情况以及肿瘤位置的符合率，以及右半结肠癌D3根治性切除实际手术方案与基于3D模型制定的方案的符合率。比较两组的手术时间、估计失血量、血管意外损伤情况、清扫淋巴结数目、首次排气时间、并发症、术后住院时间及术后引流量。
结果
3D可视化组手术时间明显短于对照组（<0.05）。两组间失血量、血管意外损伤比例、清扫淋巴结数目、首次排气时间、并发症比例、术后住院时间及术后引流量差异无统计学意义（>0.05）。3D可视化组中，3D可视化模型清晰显示了结肠的形态和走行、肿瘤位置、主要血管及肿瘤供血血管的解剖及变异情况，与手术探查结果符合率达100%。基于3D模型制定的右半结肠癌D3根治性切除手术方案与实际手术方案符合率也达100%。
结论
3D可视化重建技术能清晰显示肿瘤供血动脉及其变异情况，提高腹腔镜右半结肠癌D3根治性切除术的效率、安全性及准确性。
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