摘要
目的探讨利用三维可视化技术行3D腹腔镜胰腺中段切除术的临床应用价值。方法回顾性分析2016年12月至2020年3月间浙江大学金华医院肝胆胰外科收治的11例行3D腹腔镜下胰腺中段肿瘤切除患者的临床资料。采集患者术前二维CT图像,应用三维可视化软件对图像数据进行三维重建,立体显示肿瘤位置,观察胰腺肿瘤累及范围、肿瘤与周围脉管关系、周围肿大淋巴结情况,根据重建的图形制定具体的手术入路和手术方式,并在3D腹腔镜下完成胰腺中段切除术。结果三维重建后的胰腺中段肿瘤与邻近脏器的三维结构清楚,特别是肿瘤与动静脉以及胆总管的关系清晰。在3D腹腔镜良好的景深感和立体定位下,手术均顺利完成,无中转开腹,均行胰肠Roux-Y吻合。手术时间为(264±98)min,术中出血量为(105±82)ml。术后住院时间为6~17 d,术后出现B级胰瘘3例,通过积极引流治愈。11例患者均康复出院,无死亡。结论三维可视化技术能够对胰腺肿瘤术前进一步评估,联合3D腹腔镜行胰腺中段切除术是安全可行的。
Objective To explore the clinical value of three-dimensional visualization combined with 3D laparoscopy in the resection of middle segment pancreatectomy.Methods The clinical data of 11 patients who underwent middle segment pancreatectomy by 3D laparoscopy admitted in the Department of General Surgery of Jinhua Hospital affiliated with Zhejiang University from December 2016 to March 2020 were retrospectively analyzed.The 3D visualization software was used to reconstruct the image data collected from 2D CT images of the patients before operation,showing the three-dimensional location of the tumor,the extent of pancreatic tumor involvement,the relationship between tumor and surrounding vessels and the status of peripheral enlarged lymph nodes;according to the reconstructed figure,the specific surgical approach and procedures were determined.All the middle segment pancreatectomy was performed under 3D laparoscopy.Results Three-dimensional visualization clearly displayed the middle pancreatic tumor and the adjacent organs,especially showing the distinct relationship between the tumor and the artery,vein and common bile duct.All the surgery had been successfully completed because of the good depth of field and sterescopic image of 3D laparoscopy,and no patient was transferred to open surgery and Roux-Y pancreaticojejunostomy was performed in all the patients.The average operation time was(264±98)min,and the intraoperative blood loss was(105±82)ml.The average hospital stay ranged from 6 to 17 days after operation.There were 3 cases of grade B pancreatic fistula after operation,which were cured by active drainage and conservative treatment.All the patients recovered and discharged without death.Conclusions Three-dimensional visualization can accurately evaluate the pancreatic tumor before operation,and it combined with 3D laparoscopic middle segment pancreatectomy was safe and feasible.
作者
李仓
吴晓康
厉学民
俞世安
Li Cang;Wu Xiaokang;Li Xuemin;Yu Shian(Department of Hepatobiliary and Pancreatic Surgery,Jinhua Hospital of Zhejiang University,Jinhua 321000,China)
出处
《中华胰腺病杂志》
CAS
2020年第6期434-437,共4页
Chinese Journal of Pancreatology
基金
金华市科技局重大专项(2018-3-001a)
浙江省基础公益研究计划公益技术项目(GF20H160105)。
关键词
成像
三维
外科手术
腹腔镜检查
胰腺中段切除术
Imaging,three-dimensional visualization
Surgical procedures,operative
Laparoscopy
Middle segment pancreatectomy
