男性盆腔三维数字化重建在腹腔镜前列腺癌根治术中的应用

Application of three-dimensional digital reconstruction of male pelvic cavity in patients with laparoscopic radical prostatectomy

  • 摘要:
      目的  构建男性盆腔的数字化三维模型,探讨其在腹腔镜前列腺癌根治术中的应用价值。
      方法  选取2019年11月—2021年10月就诊于安徽医科大学附属合肥医院泌尿外科的43例男性前列腺癌患者为研究对象,随机分为实验组21例术前基于计算机断层扫描(CT)和核磁共振成像(MRI)数据进行数字化三维重建和对照组22例(采用传统二维图像进行术前规划)。比较2组患者的临床资料、手术指标及并发症发生率。
      结果  本研究成功重建了实验组21例男性患者盆腔的三维模型,并采用不同的颜色标记各个组织,可直观地展示膀胱、前列腺、精囊腺、骨盆、神经及血管等盆腔结构,还具有调整组织对比度、放大或缩小模型以及旋转等功能。本研究43例患者均成功完成腹腔镜前列腺癌根治术,术后病理结果均为前列腺腺癌。2组患者临床资料比较,差异均无统计学意义(P>0.05)。实验组平均手术时间短于对照组,差异有统计学意义(P=0.010);2组术中出血量、淋巴结转移率、切缘阳性率比较,差异均无统计学意义(P=0.114、0.705、0.488)。术后1、3个月,实验组尿失禁发生率均低于对照组,差异有统计学意义(P=0.026、0.048)。
      结论  男性盆腔结构的三维重建有助于术者规划个体化手术方案,提高腹腔镜前列腺癌根治术的疗效,缩短手术时间,降低术后尿失禁的发生率。

     

    Abstract:
      Objective  To construct a digital three-dimensional model of male pelvic cavity and explore its value in laparoscopic radical prostatectomy.
      Methods  A total of 43 male patients with prostate cancer in the Department of Urinary Surgery of Hefei Hospital Affiliated to Anhui Medical University from November 2019 to October 2021 were randomly divided into experimental group with 21 casesdigital three-dimensional reconstruction based on computed tomography (CT) and magnetic resonance imaging (MRI) data and control group with 22 cases (treated with preoperative planning based on traditional two-dimensional imaging). The clinical data, surgical indexes and incidence of complication were compared between two groups.
      Results  In this study, the three-dimensional models of the pelvic cavity of 21 male patients in the experimental group were successfully reconstructed, and each tissue was marked with different colors, which was able to directly display the pelvic structures such as bladder, prostate, seminal vesicle gland, pelvis, nerves and blood vessels, and also had the functions of adjusting tissue contrast, enlarging or reducing the model and rotation. All of the 43 patients in this study successfully completed laparoscopic radical prostatectomy, and all the postoperative pathological results showed they had prostate adenocarcinoma. There were no significant differences in clinical data between the two groups (P>0.05). The average operation time of the experimental group was significantly shorter than that of the control group (P=0.010); there were no significant differences in intraoperative bleeding, lymph node metastasis rate and positive rate of cutting edge between the two groups (P=0.114, 0.705, 0.488). At 1 month and 3 months after operation, the incidence rates of urinary incontinence in the experimental group were significantly lower than those in the control group (P=0.026, 0.048).
      Conclusion  Three-dimensional reconstruction of male pelvic structure is helpful for the operator to plan the individualized operation scheme, improve the curative effect of laparoscopic radical prostatectomy, shorten the operation time and reduce the incidence of postoperative urinary incontinence.

     

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