Application of holographic image CT three dimensional reconstruction in robotic assisted laparoscopic nephron-sparing surgery
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摘要: 目的 探讨全息影像CT三维重建技术通过选择性肾动脉分支阻断在肾部分切除术中对肾功能的保护作用。方法 回顾性分析2020年1月—2021年12月因肾脏肿瘤在陆军军医大学第一附属医院泌尿外科接受机器人辅助腹腔镜肾部分切除术并行全息影像CT三维重建的患者的临床资料。共纳入患者62例，男29例，女33例，平均年龄(53.1±11.5)岁，平均体重指数(24.1±3.3) kg/m2。根据重建结果术前制定手术方案，分为肾动脉主干阻断组(33例)和选择性分支阻断组(29例)两组。术前评估两组患者年龄、性别、体重指数、肿瘤平均直径、R.E.N.A.L.评分等一般情况，记录分析术中手术时间、热缺血时间、出血量、术后住院时间、中转主干阻断、并发症，对比分析术前及术后3 d肾功能显像(ECT)测的患肾肾小球滤过率(GFR)差值和术前及术后1个月血肌酐差值、抽血估算GFR差值等结果。结果 62例手术均成功完整切除肾脏肿瘤，切缘均为阴性，无患者中转开放或改行根治性切除术，均未发生大出血、尿瘘、感染、周围脏器损伤等并发症。两组患者在一般资料和术中出血量、手术时间、热缺血时间、术后住院时间等指标上无明显差异。选择性分支阻断组在术前及术后3 d患肾GFR差值、术前及术后1个月血肌酐差值、术前及术后1个月抽血估算GFR差值均明显小于主干阻断组(P< 0.05)。结论 全息影像CT三维重建可清晰立体地显示肾脏肿瘤、血管和周围结构的关系，有助于术中行选择性肾动脉分支阻断的肾部分切除术，选择性的肾动脉分支阻断可更好地保护肾脏功能。
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关键词:
- 全息影像CT三维重建 /
- 肾动脉选择性分支阻断 /
- 肾部分切除术
Abstract: Objective To explore the protective effect of holographic image CT three dimensional reconstruction on renal function by selective renal artery branch occlusion in partial nephrectomy.Methods The clinical data of 62 patients who underwent robotic assisted laparoscopic partial nephrectomy with holographic image CT three dimensional reconstruction for renal tumors in Department of Urology, First Affiliated Hospital of Army Medical University from January 2020 to December 2021 were collected retrospectively. There were 33 females and 29 males whose mean age was (53.1±11.5) years old and mean body mass index was (24.1±3.3) kg/m2. According to the reconstruction results, surgical plan was formulated before surgery, and patiens were divided into the main renal artery occlusion group (n=33) and the selective renal artery branch occlusion group (n=29). Preoperative evaluation of age, sex, body mass index, mean tumor diameter, R.E.N.A.L. score and intraoperative operation time, warm ischemia time, blood loss, transferring to main renal artery occlusion, complications and postoperative length of hospital stay were recorded and analyzed. Glomerular filtration rate (GFR) change by Emission Computed Tomography (ECT) of involved kidney before and 3 days after surgery, creatinine change and estimated GFR by blood drawing before and 1 month after surgery were compared between two groups.Results All of the 62 patients were completed the operation successfully with negative surgical margins and no patient was converted to open surgery or radical resection. No massive bleeding, urinary fistula, infection or injury of surrounding organs occurred. There were no significant differences in general data, intraoperative blood loss, operation time, warm ischemia time, postoperative hospital stay or other indicators between the two groups. The change of GFR by ECT before and 3 days after operation, creatinine change and estimated GFR by blood drawing before and 1 month after operation in the selective renal artery branch occlusion group were significantly lower than those in the main renal artery occlusion group (P< 0.05).Conclusion Holographic image CT three dimensional reconstruction technique can clearly and accurately display the renal tumor structure, blood vessel and the relation with surrounding tissues, helping surgeons to make better choice for performing the surgery with the selective renal artery branch occlusion partial nephrectomy so as to better protect the renal function. -
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表 1 两组患者一般资料
X±S 组别 年龄/岁 体重指数/(kg·m-2) 肿瘤平均直径/cm R.E.N.A.L.评分/分 主干阻断组(33例) 53.76±12.57 24.03±3.65 4.22±1.74 6.33±1.51 选择性分支阻断组(29例) 52.34±10.23 24.22±2.81 3.56±1.80 5.66±0.32 P 0.632 0.817 0.152 0.104 
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表 2 两组患者围手术期相关指标比较
X±S 组别 手术时间/min 热缺血时间/min 出血量/mL 术后住院时间/d 主干阻断组(33例) 124.7±36.4 18.1±4.9 119.1±103.5 4.4±0.7 选择性分支阻断组(29例) 116.9±38.0 16.1±4.6 82.8±57.5 4.7±1.8 P 0.414 0.097 0.099 0.472
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表 3 两组患者术前及术后GFR差值、血肌酐差值比较
X±S 组别 术前及术后3 d行ECT患肾GFR差值/(mL·min-1) 术前及术后1个月血肌酐差值/(μmol·L-1) 术前及术后1个月抽血估算GFR差值/(mL·min-1) 主干阻断组(33例) 20.0±8.6 10.5±9.7 13.3±9.2 选择性分支阻断组(29例) 13.6±6.8 5.0±6.4 8.2±8.3 P 0.002 0.012 0.028
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