本文選題：腎癌根治術(shù)　切入點：腎蒂血管變異　出處：《廣東醫(yī)學(xué)》2017年09期 　論文類型：期刊論文

【摘要】：目的探討基于CT的可視化腎臟三維重建模型在腎蒂血管變異患者腹腔鏡下腎癌根治術(shù)中的臨床應(yīng)用價值。方法選取患側(cè)腎蒂血管存在變異的腎細(xì)胞癌患者40例,均行腹腔鏡下腎癌根治術(shù)。其中20例患者基于CT數(shù)據(jù),利用Mimics19.0軟件,于術(shù)前進(jìn)行患側(cè)腎臟數(shù)字化三維重建,并利用三維模型進(jìn)行術(shù)前規(guī)劃和術(shù)中應(yīng)用,作為觀察組。以20例使用CT和CTA圖像進(jìn)行術(shù)前規(guī)劃的患者作為對照組。對比兩組患者的術(shù)前和術(shù)后相關(guān)數(shù)據(jù)。結(jié)果兩組患者的腫瘤大小、TNM分期、ASA評分、患側(cè)比例、腎動靜脈變異差異均無統(tǒng)計學(xué)意義(P0.05),其中觀察組患者的手術(shù)時間顯著低于對照組(t=2.410,P=0.021),兩組患者的手術(shù)出血量、術(shù)中輸血比例和血紅蛋白變化值比較差異均無統(tǒng)計學(xué)意義(P0.05),對照組中有5例(25%)患者出現(xiàn)術(shù)中并發(fā)癥,觀察組患者的并發(fā)癥發(fā)生率顯著低于對照組(X~2=7.648,P=0.006)。其中觀察組患者平均住院時間與對照組比較差異無統(tǒng)計學(xué)意義(t=0.077,P=0.939),兩組患者的隨訪均未發(fā)現(xiàn)腫瘤局部復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移病例。結(jié)論基于CT的可視化腎臟三維重建模型能為腎細(xì)胞癌合并腎蒂血管變異的患者提供可視化術(shù)前規(guī)劃和術(shù)中應(yīng)用,簡化了手術(shù)難度,可縮短手術(shù)時間和減少手術(shù)的相關(guān)并發(fā)癥。
[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.
【作者單位】： 南方醫(yī)科大學(xué)珠江醫(yī)院泌尿外科;
【分類號】：R737.11

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