Objective: To analyze the advantages of spatial measurement of anatomical parameters in a 3D model in surgical planning for laparoscopic partial nephrectomy (LPN).
Methods: From February, 2016 to October, 2017, 37 patients diagnosed with T1 renal mass underwent LPN based on 3D reconstruction after enhanced CT scanning using the Uromedix-3D system (group A), and another 38 patients received LPN with conventional CT planning (group B). The anatomical parameters were measured in the reconstructed 3D model and the demographic data, surgical outcome and postoperative data were compared between the two groups.
Results: In group A, the average time for 3D model reconstruction was (29.3∓9.7) min; the length, width and depth of the renal defect in 3D model were 3.2∓1.1 cm, 2.6∓0.9 cm and 1.7∓0.7 cm, respectively; The distance of the tumor from the collecting system was 3.8∓2.2 mm; The mean R.E.N.A.L score of the patients was 7∓1.5, and 3 patients had accessory renal artery and 2 had early branching of the renal artery. LPNs were completed via the retroperitoneal approach in all the 75 patients without conversion to open or total nephrectomy. Group A and group B showed significant differences in warm ischemic time (26.7∓6.4 vs 31.9∓7.0 min), tumor-excision time (8.4∓2.6 vs 10.4∓2.8 min), renal defect suture time (18.3∓3.9 vs 21.5∓3.4 min), 24-h volume of retroperitoneal drainage (88.6∓40.2 vs 134.3∓58.3 mL) and 48-h volume of retroperitoneal drainage (127.9∓54.5 vs 198.1∓86.3 mL), but not in the demographic data, operation time, intraoperative blood loss or postoperative hospital stay.
Conclusions: 3D reconstruction of the renal masses can be completed efficiently and accurately using this system. Compared with conventional CT-based measurement, 3D spatial measurement of the anatomical structures helps to increase the precision in the performance of LPN and reduce the warm ischemia time.
目的: 探讨3D空间测量在腹腔镜下肾部分切除术的临床应用优势。
方法: 收集2016年2月~2017年10月我院影像中心37例肾脏肿瘤的增强CT薄层数据，利用自主开发的“Uromedix-3D”系统进行3D重建，测量和分析肾脏及肿瘤的解剖参数，并指导腹腔镜下肾部分切除术（A组）。同期38例患者仅在传统CT图像指导下完成手术（B组）。统计分析两组病例的一般资料及手术资料，并进行比较。
结果: A组3D重建用时（29.3±9.7）min，3D空间测量肾脏缺损的长、宽、深分别为（3.2±1.1）cm、（2.6± 0.9）cm、（1.7±0.7）cm，肿瘤与集合系统距离为（3.8±2.2）mm；R.E.N.A.L评分（7±1.5）分；存在3例副肾动脉及2例肾动脉过早分支。AB两组手术均行后腹腔镜下肾部分切除术，肾动脉阻断时间分别为（26.7±6.4）min、（31.9±7.0）min，肿瘤切除时间分别为（8.4±2.6）min、（10.4±2.8）min，肾脏缺损缝合时间分别为（18.3±3.9）min、（21.5±3.4）min，术后24 h腹膜后引流量分别为（88.6±40.2）mL、（134.3±58.3）mL，术后48 h腹膜后引流量分别为（127.9±54.5）mL、（198.1±86.3）mL，差异均具有统计学意义（P < 0.05）。而病人一般资料、手术时间、出血量及术后住院天数等结果差异无统计学意义。
结论: “Uromedix-3D”系统能够高效、准确地完成肾脏及肿瘤的3D重建，而肾脏结构的3D空间测量比传统CT的平面测量更具优势，能够指导腹腔镜下精准化的血管处理、肿瘤切除和缺损修补等手术操作，并显著减少热缺血时间。