Zhu Rongkun,Guo Jing,Zhang Hong,et al.The applied study of computer assisted surgical system in the treatment of retroperitoneal teratoma in children.[J].Journal of Clinical Pediatric Surgery,2018,17(03):202-207.
计算机辅助手术系统在儿童腹膜后畸胎瘤手术中的应用
- Title:
- The applied study of computer assisted surgical system in the treatment of retroperitoneal teratoma in children.
- Keywords:
- Imaging; ThreeDimensional; Retroperitoneal Teratoma; Precise surgery; Child
- 文献标志码:
- A
- 摘要:
-
目的 探讨计算机辅助手术系统在儿童腹膜后畸胎瘤手术中的诊疗价值及临床意义。
方法 回顾性分析２０１３ 年８ 月至２０１７ 年８ 月青岛大学附属医院收治的１６ 例腹膜后畸胎瘤患儿的
临床资料。１６ 例患儿术前均行腹部动态增强ＣＴ 扫描，９ 例术前在增强ＣＴ 基础上行计算机辅助系统ＣＴ
三维重建，根据ＣＡＳ 重建结果进行精准的术前诊断与辅助手术规划，确定最佳手术方案。将其余７ 例
未行ＣＡＳ 三维重建的患儿作为对照组，分析两组之间手术时间、术中出血量、输血情况及康复时间等。
结果 行ＣＡＳ 三维重建的９ 例患儿术前ＣＡＳ 三维重建结果清晰地显示出腹腔大血管、实质器官、肿
瘤组织结构，可以从任意角度对肿瘤进行立体直观的观察，单独显示肿瘤与毗邻组织器官，了解肿瘤与
周围组织空间毗邻关系。ＣＡＳ 三维重建指导手术的患儿手术时间７５ ～１９０ ｍｉｎ，平均（１１１ ±３４． ４１） ｍｉｎ，
术中出血量１ ～２０ ｍＬ，平均（７ ±６． ９６） ｍＬ，输血率２２． ２２％ ，住院时间６ ～１０ ｄ，平均（７ ±１． ２７） ｄ；对照组
手术时间１１０ ～２００ ｍｉｎ，平均（１４５ ± ２９． ９２） ｍｉｎ，术中出血量２ ～ １００ ｍＬ，平均（ ３０ ± ３４． ４８） ｍＬ，输血率
４２． ９％ ，住院时间６ ～１２ ｄ，平均（８ ±２． １） ｄ，差异有统计学意义。 结论 计算机辅助手术系统三维重
建将ＣＴ 二维平面图像转化成三维立体图像，可以全维度旋转、任意缩放、任意组合清楚显示肿瘤的大
小及形态、血管的走行及形态、肿瘤与脏器及血管的解剖关系、侵犯情况，提高腹膜后畸胎瘤手术的精准
性与安全性。
- Abstract:
- ObjectiveTo explore the value of computer assisted surgical system (CAS) in precision surgery of retroperitoneal teratoma.MethodsThe clinical data of 16 hospitalized children with retroperitoneal teratoma from August 2013 to August 2017 were analyzed retrospectively.Abdominal dynamic enhanced computed tomography (CT) scan was performed preoperatively (n=16).Hisense CAS system was used for threedimensional (3D) reconstruction as reconstruction group (n=9).Based on the CAS reconstruction results，accurate preoperative diagnosis and adjuvant surgical planning were performed for determining optimal surgical protocols.The remaining 7 patients of control group underwent 3D CT reconstruction by CT Workstation.The clinical outcomes were analyzed and compared between two groups.3D reconstruction of abdominal organs and blood vessels was generated using Hisense CAS system.Diagnosis and preoperative planning assisted by the system were used for preoperative and intraoperative decisionmaking for precise surgery.ResultsThe results of threedimensional reconstruction could distinctly depict abdominal blood vessels，parenchymal organs and tumor tissue.Tumor tissues structure might be observed stereoscopically from any angle and a separate display of organs around tumor was visible for operators to understand the spatial relationship between tumor and surrounding tissue.Based upon the results of 3D reconstruction，preoperative evaluation and surgical planning were performed to reduce operative duration，blood loss and blood transfusion rate.The mean operative duration was shorter in reconstruction group than that in control group ［(111±34.41) vs (145±29.92) min，P<0.05］.The mean intraoperative blood loss was lesser in reconstruction group than that in control group ［(7±6.96) vs (30±34.48) ml，P<0.05］.The rate of blood transfusion was lower in reconstruction group than that in control group (22.22% vs 42.9%).The average hospitalization stay was shorter in reconstruction group than that in control group ［(7±1.27) vs (8±2.1) days，P<0.05)］.The difference was statistically significant.ConclusionThreedimensional visualization technology can transform 2D into 3D images and enable fulldimension rotation and zooming.Also it can depict tumor type and size，blood vessel distribution and anatomical correlation with other vessel and invasiveness in organs.It improves the safety and precision in young children undergoing retroperitoneal teratoma surgery.
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