| Background and objectives:Renal tumor,accounting for 2%～3%of all general tumors,is the second most common genitourinary neoplasm in China,which is only next to carcinoma of the bladder.Laparoscopic radical nephrectomy(LRN)is a standard surgical procedure for the treatment of localized renal cell carcinoma(RCC)because of its small trauma and high safety.The most critical step of LRN is to accurately observe the anatomical characteristics of the renal pedicle vessels and the proper control.The diagnosis of renal tumors mainly depends on imaging examination.CT and CTA,CTU and other two-dimensional images can display the normal and abnormal anatomy and renal artery branch.However,it is unable to fuse the renal pedicle vessels,kidney,tumor and the collecting system.The anatomical relationship between the organizational structure can not be clearly presented.Therefore,there are certain limitations.Digital 3D imaging technology based on enhanced CT has been widely used in clinic.However,there are few reports about the application of digital 3D reconstruction technique in the control of renal pedicle vessels in LRN.Therefore,this study is to explore the clinical value of 3D reconstruction model of renal in laparoscopic radical nephrectomy.Method40 patients with renal cell carcinoma at Zhujiang Hospital between January 2015 and March 2016 were selected.All of these patients were treated with retroperitoneal LRN surgery.CT-based 3D model of affected side of the renal was performed using Mimics 17.0 software.20 patients underwent preoperative digital 3D reconstruction before surgery,surgical planning and intraoperative application(experimental group).Another 20 patients used CT for surgical planning and intraoperative application(control group).Patient demographics,operation time,estimated blood loss,complication rate,hospital stay were analyzed.Result40 patients underwent retroperitoneal laparoscopic radical nephrectomy(LRN)successfully.There were no serious complications such as intraoperative bleeding and no transfer to open surgery.Digital three-dimensional model of renal tumor of 20 cases was established successfully in the experimental group,which can clearly reflect the structural characteristics of renal pedicle vessels,the location and the depth of the tumor as well as the existence of anatomical variation.20 operations were performed on the basis of the preoperative planning and the application in surgery based on the 3D model in experimental group.20 operations were performed on the basis of the preoperative planning and the application in surgery based on the 2D CT images in control group.After statistical analysis,it was found that the operation time of the experimental group was less than that of the control group(133±45.4min vs 160.5±39.5min,P<0.05).Estimated intraoperative blood loss was(92.5±36.4ml VS 89.5±41.2ml,P>0.05).Complication rate was(5%vs 10%,P>0.05)and the total hospital stay was(12.6±4.1d vs 12.0±2.8d,P>0.05).40 cases of patients with renal cell carcinoma were diagnosed by pathology.In the experimental group and the control group,the follow-up time of the two groups was 4.7±2.4 and 5.5±2.8 months respectively.No tumor recurrence or distant metastasis was found during follow-up.ConclusionIt is feasible and effective to establish a three-dimensional digital model of renal based on CT images,from which the anatomical characteristics of the renal pedicle vessels and the location relationship between the renal tumor and the adjacent organs were reflected.The 3D digital model of the renal can provide a comprehensive surgical planning and the application of intraoperative assistance was performed by image fusion technology based on model safely and effectively.Therefore,to a certain extent,the operation efficiency is improved and the operation time is shortened. |
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