학술논문
三维智能定性定量分析系统在双肾肿瘤精准手术规划、模拟及实施中的应用效果分析 / The planning, simulating and executing for the surgery of bilateral renal masses used the three-dimensional intelligent qualitative and quantitative analysis system(IQQA)
Document Type
Academic Journal
Author
吕建敏; 潘秀武; 干思舜; 曲发军; 叶剑青; 储传敏; 褚建; 曹建伟; 张向民; 王林辉; 崔心刚; Lyu Jianmin; Pan Xiuwu; Gan Sishun; Qu Fajun; Ye Jianqin; Chu Chuanmin; Chu Jian; Cao Jianwei; Zhang Xiangmin; Wang Linhui; Cui Xingang
Source
中华泌尿外科杂志 / Chinese Journal of Urology. 40(5):356-360
Subject
Language
Chinese
ISSN
1000-6702
Abstract
目的探讨三维智能定性定量分析(IQQA)系统在双肾肿瘤精准手术规划、模拟及实施中的应用效果.方法回顾性分析2017年6月至2018年8月收治的7例双肾肿瘤患者的病例资料,男5例,女2例.年龄平均为(54.6±6.0)岁(47.0 ～63.0岁).体质指数平均为(23.4 ±2.4)kg/m2(21.2～28.0kg/m2).7例共14枚肾肿瘤,直径平均为(3.8±1.1) cm(1.9～5.3cm);R.E.N.A.L.评分平均为(6.6±1.2)分(5.0 ～9.0分);肿瘤分期均为T1N0M0期.术前血红蛋白平均为(138.6±17.0) g/L(118.0～164.0 g/L),白蛋白平均为(47.3±2.5) g/L(44.0 ～52.0g/L),肌酐水平平均为(51.6±19.1) μmol/L(24.0 ～ 80.0μmol/L).术前患肾肾小球滤过率(GFR)平均为(56.9±6.7)ml/min(44.6 ～67.3 ml/min).术前将患者CT检查的原始数据导入IQQA系统平台,对肾脏、血管、集合系统、肿瘤进行三维重建,直接可视化肾脏、肿瘤以及脉管结构,在电脑终端进行各角度的系统化分析,开展手术切除、缝合模拟,规划肾部分切除术的方案,计算切除面积、肾脏剩余面积等,构建个体化、精准的腹腔镜肾部分切除术方案.按照术前预定的方案实施手术,11枚肿瘤行腹腔镜标准肾动脉阻断肾部分切除术,2枚肿瘤行腹腔镜选择性肾动脉阻断肾部分切除术,1枚肿瘤行腹腔镜无阻断肾部分切除术.记录7例的手术成功率、中转开放率、手术时间、热缺血时间、术中出血量、术后引流管留置时间、术后并发症、术后住院时间等指标,术后3个月随访患肾eGFR、肌酐等指标,术后6个月复查肾脏CT和肺部CT评估肿瘤学预后指标.结果本组7例的14枚肾肿瘤在IQQA系统重建以及手术规划、模拟后均顺利完成手术,无中转开放手术或改行根治性肾切除术.手术时间平均为(68.9 ±9.2)min(50.0～80.0 min),肾动脉阻断时间平均为(20.7 ±4.1)min(15.0～29.0 min),术中出血量平均为(70.7 ±29.7)m1(30.0～120.0 ml).术后引流管留置时间平均为(5.5±0.7)d(5.0～7.0 d),术后住院时间平均为(6.3 ±0.5)d(6.0～7.0 d).术后无出血、漏尿、感染、切口裂开、肺部感染等围手术期并发症发生.术后病理诊断为肾透明细胞癌13枚,肾血管平滑肌瘤1枚.术后3个月肌酐平均为(52.0±15.2) μmol/L(36.0 ～ 72.0 μmol/L),GFR平均为(56.7 ±5.3)ml/min(46.7～66.3 ml/min),与术前比较差异无统计学意义(P＞0.05).术后3个月血红蛋白平均为(120.9±17.0)g/L(90.0 ～147.0g/L),白蛋白平均为(41.4 ±2.6)g/L(38.0 ～46.0 g/L),与术前比较差异有统计学意义(P＜0.05).术后6个月复查肾脏CT、肺部CT未见肿瘤复发、转移.结论IQQA系统能够对双肾肿瘤的肾脏、肿瘤以及脉管结构进行术前三维重建可视化,术前可通过手术规划、电脑终端模拟制订最佳的肾部分切除术手术方案,提高手术的成功率和安全性,最大程度地保护肾功能,使双肾肿瘤患者在肾部分切除术中能够得到最大程度的获益.
Objective To explore the application of three-dimensional intelligent qualitative and quantitative analysis system (IQQA) in the planning,simulation and implementation of precise surgery for bilateral renal tumors.Methods A retrospective analysis a total of 7 patients with bilateral kidney tumors in our center from June 2017 to August 2018 was performed.There were 5 males and 2 females,with an average age of (54.6 ± 6.0) years,ranging 47.0-63.0 years.The average BMI index was (23.4 ± 2.4) kg/m2,ranging 21.2-28.0 kg/m2.The average diameter of 14 renal tumors in 7 patients was (3.8 ± 1.1) cm,ranging 1.9-5.3 cm.The average R.E.N.A.L score was 6.6 ± 1.2,ranging 5.0-9.0.The tumor stage was T1N0M0.The mean preoperative hemoglobin,albumin,creatinine and GFR were (138.6 ± 17.0)g/L and (47.3 ± 2.5 g/L),(51.6 ± 19.1) μmol/Land (56.9 ± 6.7) ml/min,respectively.Before operation,the original data of CT were input into IQQA system.Then we reconstructed kidney,blood vessel,collecting system and tumors using system.And the structure of kidney,tumors and vessels was visualized directly.The systematic analysis of the operation is carried out at terminals vary from various angles,and the surgical resection simulation.The position,angle and curvature of the cut surface are adjusted according to the effect.The plan of partial nephrectomy is designed.The resection area,remaining area of kidney is calculated.In this way,we can construct individualized and accurate laparoscopic partial nephrectomy planning before operation.Last,we carried out the operation according to the designed plan.The laparoscopic standard partial nephrectomy was performed in 11 cases.The laparoscopic selective partial nephrectomy was performed in 2 cases.One underwent laparoscopic partial nephrectomy without obstruction.We achieved precise resection of tumors and rapid suture of wounds according to the preoperative planning of excision and suture.We collected of the surgical success rate,conversion to opening rate,operation time,warm ischemia time,intraoperative bleeding volume,complications and hospitalization after operation.The related laboratory indicators such as eGFR and creatinine were followed up for 3 months,and the prognostic indicators such as renal CT and pulmonary CT for 6 months after operation were evaluated and analyzed.Result 14 renal tumors were successfully reconstructed by IQQA in 7 patients.The operations were completed successfully without conversion to open surgery or radical nephrectomy.The average operative duration was (68.9 ± 9.2) minutes,ranging 50.0-80.0 minutes.The average renal artery occlusion duration was (20.7 ± 4.1) minutes,ranging 15.0-29.0 minutes.The average intraoperative bleeding volume was (70.7 ± 29.7) ml,ranging 30.0-120.0 ml.The average indwelling time of drainage tube was (5.5 s0.7) days,ranging 5.0-7.0 days.The average hospitalization time was (6.3 ± 0.5) days,ranging 6.0-7.0 days.There were no perioperative complications such as bleeding,urinary leakage,infection,incision dehiscence and pulmonary infection.Postoperative pathology revealed 13 clear cell renal carcinoma and 1 renal angiomyoma.No recurrence or metastasis was found in chest CT and lung CT after 6 months follow-up.The creatinine and GFR in 3 months after operation were (52.0 ± 15.2) μmol/L(36.0-72.0 μmol/L) and (56.7 ± 5.3) ml/min(46.7-66.3 ml/min).There was no significant difference of creatinine and GFR with the preoperative (P ＞ 0.05).The mean Hb and albumin levels in 3 months after operation were (120.9 ± 17.0) g/L(90.0-147.0 g/L) and (41.4 ± 2.6) g/L (38.0-46.0 g/L),which were significantly lower than those before operation (P ＜ 0.05).Conclusions The three-dimensional intelligent qualitative and quantitative analysis system (IQQA) can visualize the kidney,tumor and the vasculature of bilateral kidney tumors by preoperative three-dimensional reconstruction.The optimal surgical plan of partial nephrectomy can be designed by preoperative operation planning and computer terminal in order to enhance the safety of partial nephrectomy for bilateral kidney tumors and preserve the possibility of kidney,and protect the renal function to the greatest extent.To accurately predict the retention of renal function after operation,so that patients with bilateral renal tumors can get the greatest benefit in partial nephrectomy.
Objective To explore the application of three-dimensional intelligent qualitative and quantitative analysis system (IQQA) in the planning,simulation and implementation of precise surgery for bilateral renal tumors.Methods A retrospective analysis a total of 7 patients with bilateral kidney tumors in our center from June 2017 to August 2018 was performed.There were 5 males and 2 females,with an average age of (54.6 ± 6.0) years,ranging 47.0-63.0 years.The average BMI index was (23.4 ± 2.4) kg/m2,ranging 21.2-28.0 kg/m2.The average diameter of 14 renal tumors in 7 patients was (3.8 ± 1.1) cm,ranging 1.9-5.3 cm.The average R.E.N.A.L score was 6.6 ± 1.2,ranging 5.0-9.0.The tumor stage was T1N0M0.The mean preoperative hemoglobin,albumin,creatinine and GFR were (138.6 ± 17.0)g/L and (47.3 ± 2.5 g/L),(51.6 ± 19.1) μmol/Land (56.9 ± 6.7) ml/min,respectively.Before operation,the original data of CT were input into IQQA system.Then we reconstructed kidney,blood vessel,collecting system and tumors using system.And the structure of kidney,tumors and vessels was visualized directly.The systematic analysis of the operation is carried out at terminals vary from various angles,and the surgical resection simulation.The position,angle and curvature of the cut surface are adjusted according to the effect.The plan of partial nephrectomy is designed.The resection area,remaining area of kidney is calculated.In this way,we can construct individualized and accurate laparoscopic partial nephrectomy planning before operation.Last,we carried out the operation according to the designed plan.The laparoscopic standard partial nephrectomy was performed in 11 cases.The laparoscopic selective partial nephrectomy was performed in 2 cases.One underwent laparoscopic partial nephrectomy without obstruction.We achieved precise resection of tumors and rapid suture of wounds according to the preoperative planning of excision and suture.We collected of the surgical success rate,conversion to opening rate,operation time,warm ischemia time,intraoperative bleeding volume,complications and hospitalization after operation.The related laboratory indicators such as eGFR and creatinine were followed up for 3 months,and the prognostic indicators such as renal CT and pulmonary CT for 6 months after operation were evaluated and analyzed.Result 14 renal tumors were successfully reconstructed by IQQA in 7 patients.The operations were completed successfully without conversion to open surgery or radical nephrectomy.The average operative duration was (68.9 ± 9.2) minutes,ranging 50.0-80.0 minutes.The average renal artery occlusion duration was (20.7 ± 4.1) minutes,ranging 15.0-29.0 minutes.The average intraoperative bleeding volume was (70.7 ± 29.7) ml,ranging 30.0-120.0 ml.The average indwelling time of drainage tube was (5.5 s0.7) days,ranging 5.0-7.0 days.The average hospitalization time was (6.3 ± 0.5) days,ranging 6.0-7.0 days.There were no perioperative complications such as bleeding,urinary leakage,infection,incision dehiscence and pulmonary infection.Postoperative pathology revealed 13 clear cell renal carcinoma and 1 renal angiomyoma.No recurrence or metastasis was found in chest CT and lung CT after 6 months follow-up.The creatinine and GFR in 3 months after operation were (52.0 ± 15.2) μmol/L(36.0-72.0 μmol/L) and (56.7 ± 5.3) ml/min(46.7-66.3 ml/min).There was no significant difference of creatinine and GFR with the preoperative (P ＞ 0.05).The mean Hb and albumin levels in 3 months after operation were (120.9 ± 17.0) g/L(90.0-147.0 g/L) and (41.4 ± 2.6) g/L (38.0-46.0 g/L),which were significantly lower than those before operation (P ＜ 0.05).Conclusions The three-dimensional intelligent qualitative and quantitative analysis system (IQQA) can visualize the kidney,tumor and the vasculature of bilateral kidney tumors by preoperative three-dimensional reconstruction.The optimal surgical plan of partial nephrectomy can be designed by preoperative operation planning and computer terminal in order to enhance the safety of partial nephrectomy for bilateral kidney tumors and preserve the possibility of kidney,and protect the renal function to the greatest extent.To accurately predict the retention of renal function after operation,so that patients with bilateral renal tumors can get the greatest benefit in partial nephrectomy.