术前 3D 渲染在微创保肝功能肝切除术中的作用。
Role of preoperative 3D rendering for minimally invasive parenchyma sparing liver resections.
机构信息
Department of Public Health, Federico II University, Naples, Italy; Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy.
Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Renal Transplant Service, Federico II University, Naples, Italy.
出版信息
HPB (Oxford). 2023 Aug;25(8):915-923. doi: 10.1016/j.hpb.2023.04.008. Epub 2023 Apr 20.
BACKGROUND
3D rendering (3DR) represents a promising approach to plan surgical strategies. The study aimed to compare the results of minimally invasive liver resections (MILS) in patients with 3DR versus conventional 2D CT-scan.
METHODS
We performed 118 3DR for various indications; the patients underwent a preoperative tri-phasic CT-scan and rendered with Synapse3D® Software. Fifty-six patients undergoing MILS with pre-operative 3DR were compared to a similar cohort of 127 patients undergoing conventional pre-operative 2D CT-scan using the propensity score matching (PSM) analysis.
RESULTS
The 3DR mandated pre-operative surgical plan variations in 33.9% cases, contraindicated surgery in 12.7%, providing a new surgical indication in 5.9% previously excluded cases. PSM identified 39 patients in both groups with comparable results in terms of conversion rates, blood loss, blood transfusions, parenchymal R1-margins, grade ≥3 Clavien-Dindo complications, 90-days mortality, and hospital stay respectively in 3DR and conventional 2D. Operative time was significantly increased in the 3DR group (402 vs. 347 min, p = 0.020). Vascular R1 resections were 25.6% vs 7.7% (p = 0.068), while the conversion rate was 0% vs 10.2% (p = 0.058), respectively, for 3DR group vs conventional 2D.
CONCLUSION
3DR may help in surgical planning increasing resectability rate while reducing conversion rates, allowing the precise identification of anatomical landmarks in minimally invasive parenchyma-preserving liver resections.
背景
3D 渲染（3DR）代表了一种有前途的手术策略规划方法。本研究旨在比较 3DR 与传统 2D CT 扫描在微创肝切除术（MILS）患者中的结果。
方法
我们对各种适应症进行了 118 次 3DR，患者接受了术前三相位 CT 扫描，并使用 Synapse3D®软件进行渲染。通过倾向评分匹配（PSM）分析，将 56 例行术前 3DR 的 MILS 患者与 127 例行传统术前 2D CT 扫描的类似患者进行比较。
结果
3DR 导致 33.9%的病例术前手术计划发生变化，12.7%的病例手术禁忌，5.9%的先前排除病例提供了新的手术适应症。PSM 在两组中分别确定了 39 名患者，在转化率、出血量、输血、实质 R1 边缘、≥3 级 Clavien-Dindo 并发症、90 天死亡率和住院时间方面，3DR 和传统 2D 组的结果具有可比性，分别为 3DR 组 402 分钟和传统 2D 组 347 分钟（p=0.020）。3DR 组血管 R1 切除率为 25.6%，传统 2D 组为 7.7%（p=0.068），而 3DR 组的转化率为 0%，传统 2D 组为 10.2%（p=0.058）。
结论
3DR 可有助于手术计划，提高可切除率，同时降低转化率，允许在微创保肝切除术时精确识别解剖标志。
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