發(fā)布時(shí)間：2018-04-06 03:29

  本文選題：數(shù)字化　切入點(diǎn)：三維模型　出處：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景和目的腎腫瘤是泌尿系統(tǒng)較常見的腫瘤之一,在我國(guó)泌尿生殖系統(tǒng)腫瘤中占第二位,僅次于膀胱腫瘤,占全身腫瘤的2%～3%。腹腔鏡下腎癌根治術(shù)(LRN)因其創(chuàng)傷小、手術(shù)安全性高等特點(diǎn),已成為治療局限性腎癌(RCC)的標(biāo)準(zhǔn)術(shù)式。LRN手術(shù)最關(guān)鍵步驟就是準(zhǔn)確了解腎蒂血管的解剖特點(diǎn)以及對(duì)其的妥善處理。腎腫瘤的診斷主要依靠影像學(xué)檢查。CT及CTA、CTU等二維圖像雖然可以顯示正常和異常的解剖關(guān)系以及腎動(dòng)脈分支,然而并不能將腎蒂血管、腎臟、腫瘤和集合系統(tǒng)相融合,組織結(jié)構(gòu)間的解剖關(guān)系無(wú)法直觀清晰地呈現(xiàn),因此,有一定的局限性�；谠鰪�(qiáng)CT的數(shù)字化三維成像技術(shù)已經(jīng)廣泛應(yīng)用于臨床。而數(shù)字化三維重建技術(shù)在LRN中腎蒂血管處理的應(yīng)用,國(guó)內(nèi)外卻鮮有報(bào)道。因此,本研究探討腎臟數(shù)字化三維重建模型在腹腔鏡下腎腫瘤根治術(shù)中的臨床應(yīng)用價(jià)值。方法本研究選取南方醫(yī)科大學(xué)附屬珠江醫(yī)院2015年1月至2016年3月40位診斷為腎腫瘤的患者,這些患者均接受了經(jīng)后腹腔的LRN手術(shù)的治療。其中20例患者,依據(jù)CT數(shù)據(jù),利用mimics17.0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(實(shí)驗(yàn)組)。其余20例患者使用CT圖像進(jìn)行術(shù)前規(guī)劃和術(shù)中應(yīng)用(對(duì)照組)。并對(duì)病人基本信息,手術(shù)時(shí)間,出血量,并發(fā)癥發(fā)生率,平均住院天數(shù)等進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果40例患者都接受了經(jīng)后腹腔入路的腹腔鏡下腎癌根治術(shù)(LRN),手術(shù)皆獲得成功。且無(wú)術(shù)中大出血等嚴(yán)重并發(fā)癥以及術(shù)中轉(zhuǎn)開放。在實(shí)驗(yàn)組中,成功建立了 20例腎臟數(shù)字化三維模型,該模型能夠清晰地反映腎蒂血管的結(jié)構(gòu)特征、腫瘤的位置和深度以及存在變異的解剖結(jié)構(gòu),20例手術(shù)均依據(jù)該模型進(jìn)行術(shù)前手術(shù)規(guī)劃和術(shù)中應(yīng)用。對(duì)照組中,20例手術(shù)均利用術(shù)前CT掃描數(shù)據(jù)進(jìn)行手術(shù)規(guī)劃和術(shù)中應(yīng)用。經(jīng)統(tǒng)計(jì)學(xué)分析后,得出實(shí)驗(yàn)組手術(shù)時(shí)間少于對(duì)照組手術(shù)時(shí)間(133.0±45.4min vs 160.5±39.5min,P0.05)。兩組中估計(jì)出血量為(92.5±36.4ml VS 89.5±41.2ml,P0.05),并發(fā)癥發(fā)生率為(5%VS 10%,P0.05),總住院天數(shù)為(12.6±4.1d VS12.0±2.8d,P0.05)。40例患者術(shù)后病理結(jié)果均為腎透明細(xì)胞癌。實(shí)驗(yàn)組與對(duì)照組中,兩組隨訪時(shí)間分別為4.7±2.4月和5.5±2.8月,隨訪期間未發(fā)現(xiàn)腫瘤復(fù)發(fā)以及遠(yuǎn)處轉(zhuǎn)移。結(jié)論基于CT圖像建立的腎臟數(shù)字化三維模型是可行和有效的,真實(shí)地反映了患側(cè)腎蒂血管的解剖特點(diǎn),及腎腫瘤與周圍毗鄰器官的位置關(guān)系。腎臟數(shù)字化三維模型可以提供全面的手術(shù)規(guī)劃,并利用圖像融合技術(shù)進(jìn)行安全有效的術(shù)中輔助應(yīng)用,并在一定程度上提高了手術(shù)效率,縮短了手術(shù)時(shí)間。
[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 鹵45.4min vs 160.5 鹵39.5 min, P 0.05).The estimated bleeding volume of the two groups was 92.5 鹵36.4ml vs 89.5 鹵41.2 ml P0.05, and the incidence of complications was 5 vs 10 and P0.05. The total hospitalization days were 12.6 鹵4.1 days VS12.0 鹵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 鹵2.4 months and 5.5 鹵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.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.11

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