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。
Objective To explore the value of computer assisted surgical system(CAS)in precision surgery of retroperitoneal teratoma. Methods The 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 three-dimensional(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 decision-making for precise surgery. Results The results of three-dimensional reconstruction could distinctly depict abdominal blood vessels,parenchymal organs and tumor tissue.Tumor tissue's 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. Conclusion Three-dimensional visualization technology can transform 2D into 3D images and enable full-dimension 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.
