三维可视化技术在复杂骨与软组织肿瘤手术中的临床应用

doi:10.3760/cma.j.cn101202-20200409-00121

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (2304 KB) HTML (2 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨三维可视化技术在复杂骨与软组织肿瘤外科手术治疗中的临床应用价值。方法回顾性研究。纳入2019年4—12月中国科学技术大学附属第一医院(西区)骨科11例复杂骨与软组织肿瘤患者的临床资料,其中男5例、女6例,年龄16～67(52.6±15.9)岁。11例患者术前均行CT常规二维扫描及三维可视化技术重建,于重建模型上观察肿瘤与周围组织尤其是血管的关系、评估肿瘤的可切除性及安全切缘、指导制定手术方案并模拟手术操作;对比常规CT二维扫描与三维可视化重建影像的观察结果,并于肿瘤切除手术中观察验证术前三维可视化重建影像评估的准确性。结果本组11例患者CT二维扫描图像经三维可视化技术重建后,可清晰显示肿瘤形态、大小及其与周围组织的关系。对比CT二维扫描影像,三维可视化技术在手术策略精准制订和指导手术操作方面更具有优势。除1例因腹腔转移未予手术治疗外,余10例患者经三维可视化技术评估后均顺利完成安全边界外肿瘤完整切除术,无血管损伤并发症发生,术中探查结果与术前三维可视化模型的判断基本一致。结论在复杂骨与软组织肿瘤术前应用三维可视化技术可以提高术前评估的准确性,指导个体化精准手术方案的制订,协助确定肿瘤外科边界并完整切除肿瘤,使患者获得更好的疗效。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	孟祥晖
	张志军
	方策
	任文涛
	胡仲翔
	高飞
	蔡善保

关键词 ：骨肿瘤, 软组织肿瘤, 三维可视化技术, 精准医疗

Abstract：Objective To explore the clinical application value of three-dimensional visualization technology in the surgical treatment of bone and soft tissue tumors.Methods The retrospective study was conducted. The clinical data of 11 patients (including 5 males and 6 females, aged 16-67 (52.6 ± 15.9) years old) with bone and soft tissue tumors in the First Affiliated Hospital of the University of Science and Technology of China (Western District) from April to December 2019 were retrospectively analyzed. All 11 patients underwent conventional two-dimensional CT scan and three-dimensional visualization technology reconstruction before operation. The relationship between tumor and surrounding tissues, especially blood vessels, was observed on the reconstructed model. The tumor's resectability and safe margins were evaluated, and the surgical plan was formulated and simulated. The observation results of conventional two-dimensional CT scan and three-dimensional visualization reconstruction image were compared during surgical operation and tumor resection to verify the accuracy of image evaluation of preoperative three-dimensional visualization reconstruction.Results The two-dimensional CT images of 11 patients were reconstructed by three-dimensional visualization technology, which clearly showed the tumor shape, size, and its relationship with surrounding tissues. Compared with two-dimensional CT scan images, three-dimensional visualization technology has more advantages in accurately formulating surgical strategies and guiding surgical operations. Except for one patient who did not receive surgical treatment due to abdominal metastasis, the remaining 10 patients successfully underwent complete resection of the tumor outside the safe boundary after the evaluation of the three-dimensional visualization technology, and no vascular injury complications occurred. The results of intraoperative exploration and preoperative three-dimensional visualization were basically the same.Conclusions The preoperative application of three-dimensional visualization technology in bone and soft tissue tumors can improve the accuracy of preoperative evaluation, guide the formulation of individualized and precise surgical plans, and assist in determining the surgical boundary of and completely remove the tumor, so that patients can obtain better curative effects.

Key words： Bone neoplasms Soft tissue neoplasms Three-dimensional visualization Precision medicine

收稿日期: 2020-04-09

通讯作者: 蔡善保,Email:shanbaocai651116@163.com

引用本文:

孟祥晖, 张志军, 方策, 任文涛, 胡仲翔, 高飞, 蔡善保. 三维可视化技术在复杂骨与软组织肿瘤手术中的临床应用[J]. 中华解剖与临床杂志, 2021, 26(1): 68-72.
Meng Xianghui, Zhang Zhijun, Fang Ce, Ren Wentao, Hu Zhongxiang, Gao Fei, Cai Shanbao. Clinical application of three-dimensional visualization technology in bone and soft tissue tumor surgery. Chinese Journal of Anatomy and Clinics, 2021, 26(1): 68-72.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200409-00121 或 http://www.cjac.com.cn/CN/Y2021/V26/I1/68

[1]	George S. Developments in systemic therapy for soft tissue and bone sarcomas[J]. J Natl Compr Canc Netw, 2019, 17(5.5): 625-628. DOI:10.6004/jnccn.2019.5020.
[2]	Yang J, Tao HS, Cai W, et al. Accuracy of actual resected liver volume in anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging[J]. J Surg Oncol, 2018, 118(7): 1081-1087. DOI:10.1002/jso.25258.
[3]	Raman SP, Horton KM, Fishman EK. MDCT evaluation of ureteral tumors: advantages of 3D reconstruction and volume visualization[J]. AJR Am J Roentgenol, 2013, 201(6): 1239-1247. DOI:10.2214/AJR.13.10880.
[4]	卢家俊, 施云涛, 史向军, 等. 三维可视化技术在腹膜后肿瘤切除术中应用研究[J]. 中国实用外科杂志, 2019, 39(9): 959-963. DOI:10.19538/j.cjps.issn1005-2208.2019.09.18. Lu JJ, Shi YT, Shi XJ, et al. Application of three-dimensional visualization technique in the resection of retroperitoneal tumor[J]. Chinese Journal of Practical Surgery, 2019, 39(9): 959-963. DOI:10.19538/j.cjps.issn1005-2208.2019.09.18.
[5]	Groeneveld B, Melles M, Vehmeijer S, et al. Developing digital applications for tailored communication in orthopaedics using a research through design approach[J]. Digit Health, 2019, 5: 2055207618824919. DOI:10.1177/2055207618824919.
[6]	周勇, 邹春华, 张朝跃. 三维可视化系统对髋关节骨性结构的评价[J]. 中国组织工程研究, 2014 (4): 601-606. DOI:10.3969/j.issn.2095-4344.2014.04.019.Zhou Y, Zou CH, Zhang CY. Evaluation of bone structure of hip joint using three-dimensional visualization system[J]. Chinese Journal of Tissue Engineering Research, 2014(4): 601-606. DOI:10.3969/j.issn.2095-4344.2014.04.019.
[7]	龚翼星, 毛晓芬, 杨波, 等. 数字医学在骨科中的应用进展[J]. 中华关节外科杂志(电子版), 2018, 12(2): 266-270. DOI:10.3877/cma.j.issn.1674-134X.2018.02.021.Gong YX, Mao XF, Yang B, et al. Application progress of digital medicine in orthopedic surgery[J]. Chin J Joint Surg(Electronic Edision), 2018, 12(2): 266-270. DOI:10.3877/cma.j.issn.1674-134X.2018.02.021.
[8]	中华医学会数字医学分会, 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会, 等. 肝胆管结石三维可视化精准诊治专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(10): 1001-1009. DOI:10.19538/j.cjps.issn1005-2208.2019.10.01.
[9]	中华医学会数字医学分会, 中华医学会外科学分会胆道外科学组, 中国研究型医院学会数字医学临床外科专业委员会. 胆囊癌三维可视化诊治专家共识(2018版)[J].中国实用外科杂志, 2018, 38(12): 1339-1346. DOI:10.19538/j.cjps.issn1005-2208.2018.12.02.
[10]	中华医学会数字医学分会, 中国研究型医院学会数字医学临床外科专业委员会. 腹膜后肿瘤三维可视化精准诊治专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(12): 1347-1353. DOI:10.19538/j.cjps.issn1005-2208.2018.12.03.
[11]	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会, 中华医学会数字医学分会, 等. 胰头癌三维可视化精准诊治专家共识[J]. 浙江医学, 2018, 40(2): 107-111. DOI:10.3760/cma.j.issn.0529-5815.2017.12.001.
[12]	中华医学会数字医学分会, 中国医师协会肝癌专业委员会, 中国医师协会临床精准医学专业委员会, 等. 复杂性肝脏肿瘤切除三维可视化精准诊治指南(2019版)[J]. 南方医科大学学报, 2020, 40(3): 297-307. DOI:10.12122/j.issn.1673-4254.2020.03.01.
[13]	Laverdière C, Corban J, Khoury J, et al. Augmented reality in orthopaedics: a systematic review and a window on future possibilities[J]. Bone Joint J, 2019, 101-B(12): 1479-1488. DOI:10.1302/0301-620X.101B12.BJJ-2019-0315.R1.
[14]	Blackwell M, Morgan F, DiGioia AM 3rd. Augmented reality and its future in orthopaedics[J]. Clin Orthop Relat Res, 1998(354): 111-122. DOI:10.1097/00003086-199809000-00014.
[15]	Heinrich F, Schwenderling L, Becker M, et al. HoloInjection: augmented reality support for CT-guided spinal needle injections[J]. Healthc Technol Lett, 2019, 6(6): 165-171. DOI:10.1049/htl.2019.0062.
[16]	Liu H, Wu J, Tang Y, et al. Percutaneous placement of lumbar pedicle screws via intraoperative CT image-based augmented reality-guided technology[J]. J Neurosurg Spine, 2020, 32(4): 542-547. DOI:10.3171/2019.10.SPINE19969.
[17]	Fang X, Zhang W, Yu Z, et al. Total ulna replacement with a 3D-printed custom-made prosthesis after en bloc tumor resection: a case report[J]. Pediatr Blood Cancer, 2019, 66(2): e27522. DOI:10.1002/pbc.27522.
[18]	Macchia G, Ferro M, Cilla S, et al. Efficacy and safety of 3D-conformal half body irradiation in patients with multiple bone metastases[J]. Clin Exp Metastasis, 2018, 35(8): 747-752. DOI:10.1007/s10585-018-9939-1.
[19]	马小军, 林艳萍, 黄亚磊, 等. 混合现实技术在骨与软组织肿瘤精准手术中的应用探索[J]. 中华解剖与临床杂志, 2019, 24(4): 322-326. DOI:10.3760/cma.j.issn.209-7041.2019.04.003.Ma XJ, Lin YP, Huang YL, et al. Application and exploration of mixed reality technology in accurate operation of bone and soft tissue tumors[J]. Chin J Anat Clin, 2019, 24(4): 322-326. DOI:10.3760/cma.j.issn.2095-7041.2019.04.003.