基于CT图像的肾脏数字化三维重建模型在腹腔镜下肾肿瘤根治术中的应用研究

发布时间：2018-04-06 03:29

本文选题：数字化　切入点：三维模型　出处：《南方医科大学》2017年硕士论文

【摘要】：背景和目的肾肿瘤是泌尿系统较常见的肿瘤之一,在我国泌尿生殖系统肿瘤中占第二位,仅次于膀胱肿瘤,占全身肿瘤的2%～3%。腹腔镜下肾癌根治术(LRN)因其创伤小、手术安全性高等特点,已成为治疗局限性肾癌(RCC)的标准术式。LRN手术最关键步骤就是准确了解肾蒂血管的解剖特点以及对其的妥善处理。肾肿瘤的诊断主要依靠影像学检查。CT及CTA、CTU等二维图像虽然可以显示正常和异常的解剖关系以及肾动脉分支,然而并不能将肾蒂血管、肾脏、肿瘤和集合系统相融合,组织结构间的解剖关系无法直观清晰地呈现,因此,有一定的局限性。基于增强CT的数字化三维成像技术已经广泛应用于临床。而数字化三维重建技术在LRN中肾蒂血管处理的应用,国内外却鲜有报道。因此,本研究探讨肾脏数字化三维重建模型在腹腔镜下肾肿瘤根治术中的临床应用价值。方法本研究选取南方医科大学附属珠江医院2015年1月至2016年3月40位诊断为肾肿瘤的患者,这些患者均接受了经后腹腔的LRN手术的治疗。其中20例患者,依据CT数据,利用mimics17.0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(实验组)。其余20例患者使用CT图像进行术前规划和术中应用(对照组)。并对病人基本信息,手术时间,出血量,并发症发生率,平均住院天数等进行统计学分析。结果40例患者都接受了经后腹腔入路的腹腔镜下肾癌根治术(LRN),手术皆获得成功。且无术中大出血等严重并发症以及术中转开放。在实验组中,成功建立了 20例肾脏数字化三维模型,该模型能够清晰地反映肾蒂血管的结构特征、肿瘤的位置和深度以及存在变异的解剖结构,20例手术均依据该模型进行术前手术规划和术中应用。对照组中,20例手术均利用术前CT扫描数据进行手术规划和术中应用。经统计学分析后,得出实验组手术时间少于对照组手术时间(133.0±45.4min vs 160.5±39.5min,P0.05)。两组中估计出血量为(92.5±36.4ml VS 89.5±41.2ml,P0.05),并发症发生率为(5%VS 10%,P0.05),总住院天数为(12.6±4.1d VS12.0±2.8d,P0.05)。40例患者术后病理结果均为肾透明细胞癌。实验组与对照组中,两组随访时间分别为4.7±2.4月和5.5±2.8月,随访期间未发现肿瘤复发以及远处转移。结论基于CT图像建立的肾脏数字化三维模型是可行和有效的,真实地反映了患侧肾蒂血管的解剖特点,及肾肿瘤与周围毗邻器官的位置关系。肾脏数字化三维模型可以提供全面的手术规划,并利用图像融合技术进行安全有效的术中辅助应用,并在一定程度上提高了手术效率,缩短了手术时间。
[Abstract]:Background and objective Renal tumor is one of the most common tumors in the urinary system. It occupies the second place in the urogenital system tumor in China, second only to the bladder tumor, and accounts for 23% of the total body tumor.LRN (LRN) has become the standard procedure for the treatment of RCCs due to its small trauma and high safety. The most important step of LRN operation is to understand the anatomical characteristics of renal pedicle vessels and to deal with them properly.The diagnosis of renal tumor mainly depends on imaging examination. Ct and CTU images can show normal and abnormal anatomical relationship and branches of renal artery, but they can not fuse renal pedicle vessels, kidney, tumor and aggregation system.The anatomical relationship between tissue structures can not be presented intuitively and clearly, therefore, there are some limitations.Digital three-dimensional imaging based on enhanced CT has been widely used in clinic.However, the application of digital three-dimensional reconstruction technique in renal pedicle vascular processing in LRN is seldom reported at home and abroad.The purpose of this study was to evaluate the clinical value of three-dimensional reconstruction model of kidney in laparoscopic radical nephrectomy.Methods from January 2015 to March 2016, 40 patients with renal neoplasms were selected from Zhujiang Hospital affiliated to Southern Medical University. All of these patients were treated with retroperitoneal LRN operation.According to CT data, 20 patients underwent digital three-dimensional reconstruction of the affected kidney before operation with mimics17.0 software, and the three-dimensional model was used for preoperative planning and intraoperative application (experimental group).The other 20 patients were used CT images for preoperative planning and intraoperative application (control group).The patient's basic information, operation time, bleeding volume, complication rate and average hospital stay were analyzed statistically.Results all 40 patients underwent laparoscopic laparoscopic radical renal cell carcinoma resection via retroperitoneal approach.No severe complications such as intraoperative hemorrhage and intraoperative conversion were observed.In the experimental group, 20 cases of kidney digital 3D model were successfully established, which can clearly reflect the structural characteristics of renal pedicle vessels.The location and depth of the tumor and the anatomical structure with variation were used in 20 cases of operation according to the model.In the control group, 20 cases underwent operation planning and intraoperative application using preoperative CT scan data.After statistical analysis, the operative time in the experimental group was less than that in the control group (133.0 卤45.4min vs 160.5 卤39.5 min, P 0.05).The estimated bleeding volume of the two groups was 92.5 卤36.4ml vs 89.5 卤41.2 ml P0.05, and the incidence of complications was 5 vs 10 and P0.05. The total hospitalization days were 12.6 卤4.1 days VS12.0 卤2.8 d P0.05. The pathological results of all 40 patients were renal clear cell carcinoma.In the experimental group and control group, the follow-up time was 4.7 卤2.4 months and 5.5 卤2.8 months, respectively. No tumor recurrence or distant metastasis was found during the follow-up period.Conclusion the three-dimensional model of kidney digitization based on CT image is feasible and effective. It reflects the anatomical characteristics of renal pedicle vessels and the relationship between renal tumor and adjacent organs.The kidney digitized 3D model can provide comprehensive operation planning, and use image fusion technology to carry out safe and effective intraoperative auxiliary application. To some extent, it can improve the operation efficiency and shorten the operation time.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.11

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