The Application Of Computer-assisted Surgery System In Pediatric Pancreatic Tumor Surgery

Part 1 Application and clinical significance of computer-assisted system in surgery for pediatric solid pseudopapillary tumorObjective Solid pseudopapilloma of the pancreas(SPTP)in children is a rare pancreatic tumor with low malignancy,which occurs mostly in young women and accounts for 2% ~6% of pancreatic exocrine tumors.The special anatomical location of the pancreas and the deep location of the pancreas make full exposure difficult,leading to limited surgical field.Because of adjacence to important large vessels and organs,and thin pancreatic vessels in children and poor tolerance of children to surgical traumatic invasion,the resection of pancreatic tumors in children needs to be more accurate and safe.The purpose of this study is to explore the value of computer-assisted surgical systems(CAS)for precise surgery in pediatric solid pseudopapillary tumor.Methods A total of 5 cases with pancreatic solid pseudopapillary tumor who were admitted to Department of Pediatrics in the affiliated hospital of Qingdao Universityfrom June 2015 to September 2018 were enrolled.Upper abdominal 64-slice dynamic enhanced computed tomography(CT)scan was performed.3D models were created by computer-assisted surgery systems.Based on 3D model,surgical planning,preoperative simulated tumor resection,intraoperative assisted guidancewere performed.Operation time,intraoperative blood loss volume,blood transfusion rate wereanalyzed.Results Hisense CAS three-dimensional reconstruction can clearly show the adjacent relationship between pancreas,tumor and peripheral vascular organs.According to the preoperative virtual resection,pancreatic tumor resection is more accurate.Postoperative pathological results were: solid pseudopapillary tumor of the pancreas.Among them,2 tumors were located in the head of the pancreas,1 was located in the pancreatic neck,and 2 in the tail of the pancreas.The operation time was 150-360 min,with an average of 279 min.The average intraoperative blood loss was 40 m L,the minimum amount of bleeding was 5 m L,and the blood transfusion rate was 40%(2/5).Surgical tumor removal was achieved successfully in 5 cases.All children were followed up 6 months to 3 years,and no recurrence or metastasis was observedConclusions Based on computer assisted surgery system,we can create a digital 3d model,displaying adjacent relation of tumor ? surrounding vessel and organs clearly.Through analyzing the 3d model and depth processing,we can also further evaluate anatomical variations of branch of the coeliac artery and portal vein systems.By preoperative design best surgery,virtual surgery,surgeons can improve the pancreas tumor resection rate and the precision and safety of operation..Part 2 Pancreatic tumor in children: a clinical analysis of 18 casesObjective To discuss the diagnosis and operations for pancreatic tumor in childrenMethod The clinical data of 18 children with pancreatic tumor who were admitted to our department from October 2002 to October 2018 were retrospectively analyzed.Cystic-solid masses were found in all patients' pancreas by imaging examination.Surgical procedures were chosen according to the tumor locationResults Ten patients underwent pylorus-preserving pancreatoduodenectomy One patient underwent local resection.One patient underwent tumor resection and ROUX-Y choledochojejunostomy.Six patients underwent distal pancreatectomy with splenectomy.Among the 18 cases followed up,one with desmoplastic small round cell tumor died after operation,and the rest showed no abnormalities.Conclusions The diagnosis and treatment of pediatric pancreatic cancer are still in the stage of exploration.Through the investigation of this study,we believe that solid pseudopapilloma and pancreatic blastoma are the two most common types in clinical practice.At present,surgical treatment is the main treatment of pancreatic tumor in children,and the pathological type of tumor is a crucial factor affecting the prognosis of children.