三维可视化重建技术在机器人辅助巨大嗜铬细胞瘤/副节瘤切除术中的应用价值（附11例报告）

帕热和·阿力木; 马文明; 冒永鑫; 戴军; 赵菊平; 方晨; 何威; 徐丹枫; 孙福康

doi:10.13201/j.issn.1001-1420.2021.01.001

三维可视化重建技术在机器人辅助巨大嗜铬细胞瘤/副节瘤切除术中的应用价值（附11例报告）

- 上海交通大学医学院附属瑞金医院泌尿外科(上海, 200025)
基金项目:
国家自然科学基金资助项目（No：81972494）；上海市卫生计生委智慧医疗专项研究项目（No：2018ZHYL0205）

详细信息

通讯作者: 孙福康,E-mail:sunfukang6@126.com

中图分类号: R736.6

收稿日期: 2020-06-27

Value of three-dimensional image reconstruction in robotic operation of massive pheochromocytoma and paraganglioma（Report of 11 cases）

- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China

More Information

Corresponding author: SUN Fukang, E-mail: sunfukang6@126.com

Received Date: 27 June 2020

摘要

摘要: 目的：探讨三维可视化重建技术在机器人辅助腹腔镜下巨大嗜铬细胞瘤/副节瘤切除术中的应用价值。方法：回顾性分析2019年7月—2020年1月我院收治的11例嗜铬细胞瘤/副节瘤患者的临床资料。其中男5例，女6例，中位年龄44（21~68）岁；肿瘤最大径中位值7.1（6.2~10.2） cm；病变位于右肾上腺3例，左肾上腺5例，右肾门旁腔静脉后方2例，左肾门旁1例。术前所有患者均行CT增强扫描，并采集dicom数据通过VitaWorks重建技术完成三维可视化模型。借助模型，观察肿瘤大小、受累脏器以及术中可能干涉的组织器官和血管，模拟手术路径，指定三维可视化指导的手术方案。结果：利用VitaWorks技术得到了所有肿瘤的精细、完整的三维可视化模型，结合肿瘤大小、部位指定精准手术方案。8例行机器人辅助经腹径路腹腔镜嗜铬细胞瘤切除术；2例行机器人辅助经腹径路腹腔镜副节瘤切除术；1例行机器人辅助经腹腹腔镜左肾上腺嗜铬细胞瘤切除术加左肾切除术。所有手术均顺利完成，无术中转开放。结论：基于CT增强扫描检查的三维可视化重建技术在机器人辅助腹腔镜下巨大嗜铬细胞瘤/副节瘤切除术方面具有应用价值，帮助术者制订精准的个体化手术方案，减少了围手术期间并发症的发生风险，提高了手术的成功率及安全性。
- 三维影像重建 /
- 机器人手术 /
- 嗜铬细胞瘤 /
- 副节瘤
Abstract: Objective: To discuss the value of three-dimensional image reconstruction in robotic operation of pheochromocytoma/paraganglioma(PHEO/PGL).Methods: From July 2019 to January 2020, the clinical data of 11 patients with PHEO/PGL were retrospectively analyzed. This study included 5 male patients and 6 female patients and the median age was 44 years old(21 to 68 years old). The median value of maximum diameter of tumor was 7.1 cm(ranged 6.2 to 10.2 cm); with 8 cases on adrenal and 3 cases on other retroperitoneal space. All patients underwent four-phase enhanced CT scanning preoperatively. The two-dimensional CT images were collected and reconstructed into a three-dimensional images model through the VitaWorks system. With the help of these 3 D images, the size and location of the tumor, as well as the relationship between tumor and vessels and peripheral organs were observed directly, so that surgeons can locate tumor and plan the operation.Results: After three-dimensional reconstruction, the 3 D image clearly showed the location of tumor and its relationship with surrounding vessels and organs. All patients underwent robot assisted laparoscopic surgery without intra-operative conversion to open surgery.Conclusion: Three-dimensional image construction is valuable for surgery of massive PHEO/PGL and provides an objective basis for decision of surgeon to acquire better perioperative results.
- three-dimensional image construction /
- robotic surgery /
- pheochromocytoma /
- paraganglioma

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参考文献(19)

[1]	Huang J, Lü S, Hu Z, et al.Three-dimensional reconstruction of human kidney based on UroMedix-3D system and its application in kidney surgery[J].Nan Fang Yi Ke Da Xue Xue Bao, 2019, 39(5):614-620.
[2]	许华权.CT增强扫描在腹膜后肿瘤和肿瘤样病变中的诊断价值[J].中国高等医学教育, 2016, 6:132-133.
[3]	张伟.CT、MR对腹膜后原发肿瘤诊断临床价值分析[J].中国医疗器械信息, 2018, 24(4):143-145.
[4]	Fang CH, Tao HS, Yang J, et al.Impact of three-dimensional reconstruction technique in the operation planning of centrally located hepatocellular carcinoma[J].J Am Coll Surg, 2015, 220(1):28-37.
[5]	Silberstein JL, Maddox MM, Dorsey P, et al.Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers:a pilot study[J].Urology, 2014, 84(2):268-272.
[6]	Komai Y, Sakai Y, Gotohda N, et al.A novel 3-dimensional image analysis system for case-specific kidney anatomy and surgical simulation to facilitate clampless partial nephrectomy[J].Urology, 2014, 83(2):500-506.
[7]	毛全宗, 张震宇, 郭雪涛, 等.基于CT dicom数据3D全息可视化成像在肾及腹膜后巨大肿瘤精准手术的应用[J].北京医学, 2019, 41(7):535-537.
[8]	胡操阳, 王东文, 张彬, 等.三维重建辅助3D腹腔镜在高选择性肾动脉阻断肾部分切除术中的应用[J].中国药物与临床, 2017, 17(4):517-519.
[9]	朱国栋, 汤聪, 宋文斌, 等.肾上腺嗜铬细胞瘤/副神经节瘤患者137例手术疗效分析[J].现代泌尿外科杂志, 2017, 22(8):598-602.
[10]	赵磊, 江山, 周骏, 等.嗜铬细胞瘤术中发生血流动力学不稳定相关术前危险因素研究(附125例报告)[J].临床泌尿外科杂志, 2019, 34(9):699-703.
[11]	汪金荣, 何乐业, 刘斌.应用达芬奇机器人切除原发性腹膜后巨大肿瘤的临床研究[J].中国内镜杂志, 2019, 25(8):80-84.
[12]	张小华, 王先进, 高逢彬, 等.经腹腔途径机器人辅助腹腔镜下肾上腺手术的经验总结(附243例报告)[J].中华泌尿外科杂志, 2017, 38(4):277-280.
[13]	Nel D, Panieri E, Malherbe F, et al.Surgery for Pheochromocytoma:A Single-Center Review of 60 Cases from South Africa[J].World J Surg, 2020, 44(6):1918-1924.
[14]	Tsuboi M, Noda H, Watanabe F, et al.Complete resection of a complicated huge mesenteric lymphangioma guided by mesenteric computed tomography angiography with three-dimensional reconstruction:report of a case[J].Int Surg, 2015, 100(3):574-578.
[15]	Yiannakopoulou E.Robotic assisted adrenalectomy:Surgical techniques, feasibility, indications, oncological outcome and safety[J].Int J Surg, 2016, 28:169-172.
[16]	陆洪炳.三维可视化技术在特殊肝段肝癌切除术中的应用研究[J].肝脏, 2019, 24(12):1458-1460.
[17]	杨悦, 曹智, 张超, 等.IQQA三维立体成像导航技术支持下最大限度保留肾门结构的肾门肿瘤腹腔镜下肾部分切除术的初步体会[J].中华泌尿外科杂志, 2017, 38(7):493-497.
[18]	Arfi A, Arfi-Rouche J, Barrau V, et al.Three-dimensional computed tomography angiography reconstruction of the origin of the uterine artery and its clinical significance[J].Surg Radiol Anat, 2018, 40(1):85-90.
[19]	Zhang B, Chen Z, Hu X, et al.Application of Three-Dimensional Visualization Technology in Laparoscopic Surgery for Pheochromocytoma/Paraganglioma:A Single-Center Experience[J].J Laparoendosc Adv Surg Tech A, 2018, 28(8):997-1002.