基于CT的肾脏可视化三维重建模型在肾蒂血管变异的肾癌根治术中的应用

发布时间：2018-03-05 08:54

本文选题：肾癌根治术　切入点：肾蒂血管变异　出处：《广东医学》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨基于CT的可视化肾脏三维重建模型在肾蒂血管变异患者腹腔镜下肾癌根治术中的临床应用价值。方法选取患侧肾蒂血管存在变异的肾细胞癌患者40例,均行腹腔镜下肾癌根治术。其中20例患者基于CT数据,利用Mimics19.0软件,于术前进行患侧肾脏数字化三维重建,并利用三维模型进行术前规划和术中应用,作为观察组。以20例使用CT和CTA图像进行术前规划的患者作为对照组。对比两组患者的术前和术后相关数据。结果两组患者的肿瘤大小、TNM分期、ASA评分、患侧比例、肾动静脉变异差异均无统计学意义(P0.05),其中观察组患者的手术时间显著低于对照组(t=2.410,P=0.021),两组患者的手术出血量、术中输血比例和血红蛋白变化值比较差异均无统计学意义(P0.05),对照组中有5例(25%)患者出现术中并发症,观察组患者的并发症发生率显著低于对照组(X~2=7.648,P=0.006)。其中观察组患者平均住院时间与对照组比较差异无统计学意义(t=0.077,P=0.939),两组患者的随访均未发现肿瘤局部复发及远处转移病例。结论基于CT的可视化肾脏三维重建模型能为肾细胞癌合并肾蒂血管变异的患者提供可视化术前规划和术中应用,简化了手术难度,可缩短手术时间和减少手术的相关并发症。
[Abstract]:Objective to investigate the clinical value of three-dimensional renal reconstruction model based on CT in laparoscopic radical renal cell carcinoma (RCC) patients with renal pedicle vascular variation. Methods 40 patients with renal cell carcinoma with variant renal pedicle vessels were selected. All patients underwent laparoscopic radical nephrectomy, 20 of them underwent digital 3D reconstruction of the affected kidney before operation using Mimics19.0 software based on CT data, and the 3D model was used for preoperative planning and intraoperative application. As the observation group, 20 patients with preoperative planning using CT and CTA images were used as the control group. The relevant data of the two groups were compared before and after operation. Results the tumor size of the two groups was evaluated by TNM staging and ASA score, and the ratio of the affected side was compared between the two groups. There was no significant difference in renal arteriovenous variation (P 0.05). The operative time of the patients in the observation group was significantly lower than that in the control group (2.410g / kg), and the amount of operative bleeding in the two groups was significantly lower than that in the control group (P < 0.05). There was no significant difference in blood transfusion ratio and hemoglobin change value between the two groups. In the control group, there were 5 patients with intraoperative complications. The incidence of complications in the observation group was significantly lower than that in the control group. The average hospitalization time of the patients in the observation group was not significantly different from that in the control group. There was no significant difference between the observation group and the control group in the incidence of complications. No local recurrence or distant metastasis was found in the follow-up of the two groups. Conclusion the three-dimensional reconstruction model of kidney based on CT can provide visual preoperative planning and intraoperative application for patients with renal cell carcinoma complicated with renal pedicle vessel variation. It simplifies the operation difficulty, shortens the operation time and reduces the complications associated with the operation.
【作者单位】：南方医科大学珠江医院泌尿外科;
【分类号】：R737.11

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