Zhu RK,Zhang H,Jing XY,et al.Application of computeraided surgical system for repeated renal surgery in children.[J].Journal of Clinical Pediatric Surgery,2019,18(02):118-123.
计算机辅助手术系统在小儿重复肾精准手术中的应用
- Title:
- Application of computeraided surgical system for repeated renal surgery in children.
- Keywords:
- Repeated Kidney; Computerassisted; Threedimensional; Surgical Procedures; Operative; Therapy
- 文献标志码:
- A
- 摘要:
- 目的探讨海信计算机辅助手术系统（Hisense CAS）在小儿重复肾精准外科手术中的诊疗价值及临床意义。方法回顾性分析2013年1月至2017年6月青岛大学医学院附属医院收治的35例重复肾患儿的临床资料，利用海信计算机辅助手术系统对患儿腹部、盆腔薄层CT图像进行泌尿系统CT三维重建和术前规划，准确判断重复肾的位置、大小，肾脏周围血管系统走行、分支及毗邻关系，输尿管走行、狭窄段等，明确手术的可行性及手术方案，分析手术时间、术中出血量、输血率、并发症等。结果35例重复肾患儿CAS三维重建结果清晰显示重复肾的位置、大小、毗邻关系及重复肾周围血管的走行、分支等。35例重复肾患儿中，左侧19例，右侧13例，双侧3例；完全性重复肾32例，不完全性重复肾（Y型输尿管）3例；35例均为上位型，重复肾肾盂输尿管扩张、积水35例，其合并上肾段输尿管末端囊肿9例（下肾段双输尿管Y性吻合并上肾段输尿管末端囊肿1例），合并Y型输尿管、下肾段肾盂-输尿管连接处狭窄1例，合并上、下肾发育不良1例。 1例行单侧肾切除术，1例行肾盂成形术，32例行肾-输尿管切除术，1例行输尿管-膀胱吻合术; 2例二次手术行囊肿切除。手术时间50~210 min，平均为122.8 min,术中平均出血量12.91 mL，最少出血量为1 mL。35例中有2例术后输注1 u红细胞，术后平均住院时间9 d，均痊愈出院。结论通过海信计算机辅助手术系统对CT数据进行三维重建并辅助设计最优手术方案，可提高重复肾手术切除的准确性、安全性。
- Abstract:
- ObjectiveTo explore the value and clinical significance of Hisense computeraided surgical system (Hisense CAS) for repeated renal biopsy in children.MethodsRetrospective analysis was conducted for 35 hospitalized children with repeated kidney from January 2013 to June 2017.All children underwent threedimensional preoperative reconstruction of CAS.Efforts were made for accurately determining the location and size of repeated kidney,renal vascular system,peripheral branches and adjacent structures,ureteral course and stenosis,etc.Surgical feasibility,detailed procedures,operative duration,volume of intraoperative blood loss and blood transfusion rate were analyzed.ResultsCAS threedimensional reconstruction revealed distinctly the location and size of repeated kidney and its adjacent anatomic structures.The sideness of repeated kidney was left (n=19),right (n=13) and bilateral (n=3).Repeated renal pelvic dilation was accompanied by hydronephrosis (n=35).Among 9 cases of upper ureteral terminal cyst,there were lower bilateral ureteral Y anastomosis plus upper ureteral terminal cyst (n=1),Ytype ureteral plus lower pelvicureteral junction stenosis (n=1) and upper & lower renal dysplasia (n=1).Unilateral nephrectomy (n=1),glenoid angioplasty (n=1),pediatric ureteroscopy (n=32),ureteralbladder anastomosis (n=1) and secondary surgical cyst resection (n=2) were performed.The average operative duration was 122.8 min and the average volume of intraoperative blood loss 12.91 ml.Two cases required a postoperative infusion of 1U red blood cells.The average postoperative hospitalization stay was 9 days predischarge.ConclusionThreedimensional visualization provides preoperative assessments to allow for individualized surgical planning.Surgical controllability,accuracy and safety may be improved in infants and toddlers undergoing precise repeated renal surgery.
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