南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (5): 760-765.doi: 10.12122/j.issn.1673-4254.2022.05.19

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三维重建技术在腹腔镜右半结肠癌D3根治术中的应用

陈建新，袁燕文，彭伟谦，唐煜欣，陈新岐，王毅钧，沈海平，李瑞平   

  1. 南方医科大学附属东莞医院普外科，消化内科，放射科，广东 东莞 523059
  • 出版日期:2022-05-20 发布日期:2022-05-09

Application of three-dimensional visualization technique in laparoscopic D3 radical resection of right colon cancer

CHEN Jianxin, YUAN Yanwen, PENG Weiqian, TANG Yuxin, CHEN Xinqi, WANG Yijun, SHEN Haiping, LI Ruiping   

  1. Department of Gastrointestinal Surgery, Department of Gastroenterology, Department of Radiology, Dongguan People's Hospital Affiliated to Southern Medical University, Dongguan 523059, China
  • Online:2022-05-20 Published:2022-05-09

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摘要： 目的 探讨三维重建技术对右半结肠癌患者施行腹腔镜D3根治术的临床应用价值。方法 对2019年5月~2021年3月接受腹腔镜右半结肠癌D3根治术的73例患者的临床资料进行回顾性分析，按术前检查将患者分为实验组（41例）和对照组（32例）。实验组术前行薄层增强CT检查后运用重建软件进行三维重建并指导实际手术，对照组术前只行常规增强CT检查，观察实验组术中探查血管变异、肿瘤动脉供血、肿瘤定位等情况与三维可视化重建模型符合率、根据三维模型术前拟定的结直肠癌D3根治术手术方案与实际手术方案符合率、两组病例的手术时间、术中出血量、血管意外损伤比例、淋巴结清扫数量、肛门通气时间、并发症比例、术后住院时间、腹腔总引流量等指标。结果 实验组比对照组手术耗时更短（P<0.05），在术中出血量、血管意外损伤比例、淋巴结清扫数量、术后肛门通气时间、并发症比例、术后住院时间以及腹腔引流量等方面，两组差异无统计学意义（P>0.05）。实验组利用三维重建技术术前清晰显示结肠形态和走向、肿瘤位置、各主要血管的解剖与变异以及癌肿供血血管，与实际手术探查符合率100%，根据三维模型术前拟定的右半结肠癌D3根治术手术方案与实际手术方案符合率100%。结论 三维重建技术可以直观地显示右半结肠癌的血管解剖和变异、以及肿瘤与供血动脉的关系，能更安全有效地从肿瘤学角度施行腹腔镜右半结肠癌D3根治手术。

关键词: 三维重建技术；腹腔镜；右半结肠癌；D3根治术

Abstract: 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 (P<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 (P>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.

Key words: 3D visualization technology; laparoscopy; right colon cancer; D3 radical resection