摘要
目的 探讨CT三维重建及3D打印技术在复杂的腹膜后肿瘤手术中的应用价值。方法 回顾性分析2020年7月至2021年11月广东省中医院收治的13例复杂的腹膜后肿瘤患者临床资料。患者术前均行增强CT检查和三维重建并采用3D打印技术建立肿瘤模型。通过观察CT三维图像与3D打印模型仔细研究肿瘤的大小、位置及其与周围脏器的关系,并进行模拟切除,制定个体化手术方案。观察记录模拟手术方案与实际手术方案符合情况,肿瘤完整切除情况,周围脏器联合切除情况,肿瘤最大径、重量,手术时间、术中出血量、术后住院时间、病理检查结果、术后并发症及随访结果等指标。结果 13例患者术前均完成肿瘤CT三维重建并3D打印肿瘤模型,清晰显示肿瘤部位、立体解剖形态及其与周围血管的位置关系。术前模拟手术方案与术中实际手术方案符合比例为13/13。所有病例均实现肿瘤完整切除,13例患者中单纯切除肿瘤3例,联合脏器切除10例,共切除32个脏器,切除肿瘤中位最大径为21.5(11.4,29.9)cm,中位重量为4 130.0(585.5,11 300.0)g,中位手术时间为193(154,266)min,中位术中出血量为200(150,600)mL,中位术后住院时间为6(5,7)d。术后病理诊断:脂肪肉瘤8例、血管肉瘤2例、神经母细胞瘤1例、囊性间皮瘤1例、嗜铬细胞瘤1例。围手术期发生肠瘘1例、无死亡病例。术后中位随访时间为9(4,15)个月,无肿瘤局部复发或远处转移病例。结论 CT三维重建及3D打印技术可精准显示腹膜后肿瘤与其周围脏器的复杂解剖关系,并可在术前进行模拟手术,有助于术前制定个体化的手术策略、术中精准导航及术后结果对比,可提高腹膜后肿瘤手术治疗的安全性和有效性。
Objectives To explore the clinical application of three-dimensional CT reconstruction and printing technology in the resection of complicated retroperitoneal tumors. Methods Thirteen patients with complicated retroperitoneal tumors treated at Guangdong Provincial Hospital of Traditional Chinese Medicine from July 2020 to November 2021 were retrospectively reviewed.Three-dimensional CT reconstruction and printing model were made from contrast-enhanced CT scans for each patient before surgery. The tumor location and size and its relation to the surrounding organs were analyzed according to the three-dimensional CT reconstruction and printing model. Simulated resection was performed, individualized treatment regimens were designed. Observe and record the consistency between the simulated operation scheme and the actual operation scheme, completed resection of tumor, combined resection of surrounding organs, maximum diameter of tumor, the tumor weight, operation time, intraoperative blood loss, postoperative hospital stay, pathological results, complications and follow up results. Results All the tumors were printed with the 3-dimensional model, which can display the location, anatomy, and relationship with surrounding blood vessels.The consistency proportion median between simulated surgery and the actual surgery was 13/13. Completed resection was successfully performed in all cases. Among the 13 patients, there were 3 cases of simple tumor resection and 10 cases of combined organ resection, total of 32 organs were resected. The median length of the resected tumor was 21.5(11.4, 29.9) cm. The median weight of the resected tumor was 4 130.0(585.5, 11 300.0) g. The median operation time was 193(154, 266) min, median intraoperative blood loss was 200(150, 600) mL, and the median postoperative hospital stay was 6(5, 7) d. Perioperative intestinal fistulas occurred in 1 patient. No perioperative death occurred. No recurrence or metastasis occurred during the 9(4, 15) months of follow-up. Conclusion Three-dimensional CT reconstruction can accurately display the anatomic relationship between tumors and their surrounding organs, effectively simulate complex retroperitoneal tumor resection. It is helpful for preoperative surgery design, accurate intraoperative navigation, and comparison of operative results.
作者
林佳鑫
刁德昌
廖伟林
汪佳豪
李洪明
易小江
卢新泉
冯晓创
陈昭宇
Lin Jiaxin;Diao Dechang;Liao Weilin;Wang Jiahao;Li Hongming;Yi Xiaojiang;Lu Xinquan;Feng Xiaochuang;Chen Zhaoyu(The Second Clinical Medical School,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;Gastrointestinal Cancer Center/Department of Colorectal Surgery,Guangdong Provincial Hospital of Traditional Chinese Medi-cine,Guangzhou 510120,Guangdong,China)
出处
《结直肠肛门外科》
2022年第2期119-123,共5页
Journal of Colorectal & Anal Surgery
基金
广州市科技计划项目(202102010240)。
关键词
腹膜后肿瘤
CT三维重建
3D打印
手术方案
retroperitoneal tumors
three-dimensional CT reconstruction
3D printing
operation scheme
