目的 探讨基于CT断层扫描影像数据融合的三维可视化技术及数字泌尿外科虚拟诊疗在肾上腺肿瘤中的应用价值。 方法 选取贵阳市第二人民医院泌尿外科2016年9月~2023年04月期间收治的肾上腺肿瘤手术患者进行回顾性分析。共纳入病例19例，三维重建肾上腺肿瘤（3D组）12例(男性3例，女性9例)，平均年龄（44.92±13.28）岁。3D组12例患者均在术前使用增强CT影像数据进行三维重建，并使用重建模型了解肿瘤及占位位置，以及肿瘤处与血管及周围组织器官的关系，依据三维可视化模型制定手术计划、术中指导及进行医患沟通。未三维重建手术(CT组)7例(男性3例，女性4例)，平均年龄（35.14±11.25）岁。比较两组患者的一般资料、手术方法、围手术期数据,并使用SPSS 26.0进行数据分析和处理。 结果 19例手术中，18例手术均顺利完成，CT组1例手术因术前评估不够精确，术中发现肿瘤巨大、解剖关系复杂，无法显露完整肿瘤、中央静脉和肾静脉，转为开放手术。3D组患者的手术时间小于CT组，差异具有统计学意义（P<0.05）。两组一般资料（性别、年龄）、术中出血量、术后住院时间和拔除引流管时间相比，差异均无统计学意义（P>0.05）。 结论 三维可视化及实景重建技术是构建数字泌尿外科虚拟诊疗的重要基础，三维重建模型可以减少肾上腺肿瘤手术中的解剖迷失以实现术中精准切除，从而缩短手术时间。有利于降低手术风险，在泌尿外科具有较高的临床应用价值，值得进一步临床应用及推广。
Abstract
Objective To explore the application value of 3D reconstruction technology of CT scanning and digital virtual surgery diagnosis and treatment system in adrenal tumors. Methods Data on 20 patients diagnosed with adrenal tumors and completed 3D reconstruction in The Second People′s Hospital of Guiyang from September 2016 to April 2023 were reviewed. A total of 19 cases were collected, including 12 cases of three-dimensional reconstruction adrenal tumors (3D group), 3 males and 9 females, with the mean age of (44.92±13.28) year. All the 12 patients in 3D group were three-dimensional reconstructed with enhanced CT image data before operation, and the reconstructed model was used to understand the tumor and its occupying position, as well as the relationship between the tumor and blood vessels and surrounding tissues and organs. The operation plan, intraoperative guidance and doctor-patient communication was made according to the 3D reconstruction image. There were 7 cases without three-dimensional reconstruction (CT group), the mean age was (35.14±11.25) years. There were 3 males and 4 females in the CT group. The general information, surgical methods and perioperative data of the two groups were compared. The data were analyzed by using SPSS 26.0. Results Among the 19 cases, 18 cases were successfully completed. One case in the CT group was converted to open surgery due to insufficiently accurate preoperative evaluation, which resulted in the discovery of a huge tumor and complex anatomical relationship during the operation, and the inability to expose the complete tumor, central vein and renal vein. The operation time in the 3D group was shorter than that in the CT group, with a statistically significant difference (P<0.05). There were no significant differences in general information(age and gender), intraoperative bleeding volume, postoperative length of stay, and drainage tube removal time between the two groups (P>0.05). Conclusions 3D visualization and realistic reconstruction technology is an important foundation for construction of virtual diagnosis and treatment of digital urology. 3D reconstruction models can reduce anatomical disorientation in adrenal tumor surgery to achieve accurate intraoperative resection, thereby shortening the surgical time. It is beneficial to reduce surgical risk and has high clinical application value in urology surgery, which is worth of further clinical application and promotion.
关键词
三维可视化技术； /
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数字虚拟诊疗； /
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数字泌尿外科学； /
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肾上腺肿瘤； /
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实景重建
Key words
Three-dimensional visualization technology; /
Digital virtual diagnosis and treatment; /
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Digital urology; /
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Adrenal tumors; /
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Reality reconstruction
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基金
贵阳市科技计划项目（筑科合同[2019]9-9-3号）；贵阳市人才创新创业资助项目（筑人才办合同字[2019]第33号）；贵州省卫生健康委员会科学技术基金项目（黔卫发gzwjkj2019-1-080）；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）
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