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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 372 -379. doi: 10.3877/cma.j.issn.1674-3253.2024.04.012

临床研究

基于CT的三维重建模型及术前虚拟手术在输尿管狭窄腹腔镜手术中的应用研究
张云浩1, 何玲敏2, 孙旭3, 马洪贵4, 刘磊2, 张见荣2, 梅傲冰5,()   
  1. 1. 550002 贵阳,贵州中医药大学;550081 贵阳,贵阳市第二人民医院泌尿外科
    2. 550004 贵阳,贵州医科大学
    3. 550004 贵阳,贵州医科大学附属医院小儿外科
    4. 550004 贵阳,贵州医科大学附属医院泌尿外科
    5. 550081 贵阳,贵阳市第二人民医院泌尿外科
  • 收稿日期:2024-05-15 出版日期:2024-08-01
  • 通信作者: 梅傲冰
  • 基金资助:
    贵州省卫生健康委员会科学技术基金项目(黔卫发gzwjkj2019-1-080); 贵阳市人才创新创业资助项目(筑人才办合同字[2019]第33号); 贵州省高层次创新型人才遴选培养计划项目(黔委人领办发(2022)3号;筑科合同-GCC[2022]16号)

Application of 3D reconstruction technology and virtual surgery in laparoscopic ureteral stricture surgery

Yunhao Zhang1, Lingmin He2, Xu Sun3, Honggui Ma4, Lei Liu2, Jianrong Zhang2, Aobin Mei5,()   

  1. 1. Guizhou University of Traditional Chinese Medicine, Guiyang 550002, China; Department of Urology, the Second People′s Hospital of Guiyang, Guizhou 550081, China
    2. Guizhou Medical University, Guiyang 550004, China
    3. Department of Pediatric Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
    4. Department of Urology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
    5. Department of Urology, the Second People′s Hospital of Guiyang, Guizhou 550081, China
  • Received:2024-05-15 Published:2024-08-01
  • Corresponding author: Aobin Mei
引用本文:

张云浩, 何玲敏, 孙旭, 马洪贵, 刘磊, 张见荣, 梅傲冰. 基于CT的三维重建模型及术前虚拟手术在输尿管狭窄腹腔镜手术中的应用研究[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 372-379.

Yunhao Zhang, Lingmin He, Xu Sun, Honggui Ma, Lei Liu, Jianrong Zhang, Aobin Mei. Application of 3D reconstruction technology and virtual surgery in laparoscopic ureteral stricture surgery[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(04): 372-379.

目的

探讨三维(3D)重建技术及术前虚拟诊疗在输尿管狭窄腹腔镜手术中应用价值。

方法

选择2016年10月至2022年9月贵阳市第二人民医院及贵州医科大学附属医院泌尿外科收治的输尿管狭窄住院患者病例资料进行分析,共纳入19例。3D组以CT数据重建三维可视化模型进行手术规划,共8例(男5例,女3例);CT组以CT影像进行手术规划,共11例(男7例,女4例)。CT组术前通过CT影像确定患者输尿管狭窄部位、长度及程度。3D组术前术者通过3D重建模型明确狭窄部位的解剖关系和精准定位,使用3D重建软件(IPS)中的手术入路点计算、虚拟软镜、穿刺模拟和虚拟切除等功能进行术前模拟,最终全部患者均行经腹腹腔镜下输尿管重建手术。

结果

19例手术均顺利完成,无一例中转成开放手术。3D组术中出血量明显小于CT组,差异具有统计学意义(P<0.05)。两组一般情况(性别、年龄、部位)、术后住院时间、术后引流时间、手术时间对比差异均无统计学意义(P>0.05)。

结论

3D重建技术及术前虚拟手术可辅助术者制定个体化手术方案以实现精准切除及修复,可减少术中出血,对输尿管狭窄腹腔镜手术中提高手术安全性具有较高的临床应用价值,值得进一步推广及应用。

Objective

To explore the application value of 3D reconstruction technology and virtual diagnosis and treatment in laparoscopic ureteral stricture.

Methods

The data of patients with ureteral stricture admitted to the Second People's Hospital of Guiyang and Affiliated Hospital of Guizhou Medical University from October 2016 to September 2022 was analyzed. A total of 19 cases were included. There were 8 patients (5 males and 3 females) in the 3D group, the surgical planning was carried out with the 3D reconstruction visual model of CT data. Another 11 cases (7 males and 4 females) were in CT group, the surgical planning was carried out with the CT images. In the CT group, the location, length and degree of ureteral stenosis were determined by CT images before operation. In the 3D group, the preoperative operators used the 3D reconstruction model to determine the anatomical relationship and accurate positioning of the stenosis sites, and used the functions of the 3D reconstruction software (IPS) to calculate the surgical approach point, virtual flexible ureteroscope, puncture simulation and virtual resection to conduct preoperative simulation. Finally, all patients underwent transabdominal laparoscopic ureteral reconstruction surgery.

Results

All 19 cases were successfully completed the surgery, and no case was converted to open surgery. The amount of blood loss in 3D group was significantly lower than that in CT group (P<0.05). There were no significant differences in the general situation (gender, age, location), postoperative hospitalization time, postoperative drainage time, and operation time between the two groups (P>0.05).

Conclusions

3D reconstruction technology and preoperative virtual surgery can assist surgeons to make individual surgical plans to achieve accurate resection and repair, reduce during operation bleeding, which has high clinical application value for improving surgical safety in laparoscopic ureteral stricture surgery, and is worthy of further promotion and application.

图1 右侧输尿管狭窄患者CT扫描三维重建注:图a、b和c为动静脉、肾脏及输尿管重建,图d、e和f为膀胱、阴道及骨骼的重建
图2 左侧输尿管狭窄虚拟手术过程注:图a为手术入路及切割平面模拟;b为穿刺点虚拟定位;c为狭窄处穿刺模拟;d为狭窄段长度计算;e为输尿管狭窄部位倾斜角度计算;f为狭窄段移除;g为模拟输尿管狭窄处切除后;h为狭窄段修复吻合;i为模拟输尿管狭窄段修复后
图3 右侧输尿管狭窄CT图像与三维重建模型对比注:a1和a2为输尿管狭窄冠状面;b1和b2为输尿管狭窄矢状面;c1和c2为输尿管狭窄横切面;在a1,b1和c1中,肾脏用紫色表示,输尿管用绿色表示,狭窄处用黄色表示
图4 左侧输尿管下段狭窄三维重建图注:图a示左侧输尿管狭窄位于输尿管膀胱交界处;图b示左输尿管与右输尿管体积比较明显扩张
图5 双侧输尿管上段狭窄三维重建图注:图a示双侧狭窄及狭窄部位与外周血管的解剖关系;图b显示左侧狭窄上方输尿管结石
表1 两组输尿管狭窄患者一般资料比较
表2 两组输尿管狭窄患者围手术期指标对比[MQ)]
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