基于CT图像应用Mimics软件的三维重建技术在腹腔镜直肠癌D3根治术中的价值
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摘要
目的:利用Mimics软件进行肠系膜下动脉(IMA)三维重建,并评估其在腹腔镜直肠癌D3根治术中的应用价值。方法:回顾性分析2016年6月至2018年1月期间行腹部增强CT检查的71例直肠癌患者的影像学资料,利用Mimics软件对该影像数据行IMA三维重建,归纳总结4种IMA分支类型所占的比例,并测量IMA根部到腹主动脉分叉的直线距离以及IMA根部至左结肠动脉(LCA)的直线距离。然后,将2018年1月～8月入院的30例直肠癌患者随机分成对照组(术前未行IMA三维重建)和观察组(术前根据IMA三维重建制定手术方案),每组15例。前瞻性分析两组患者的术中相关指标(手术时间、术中出血量、术中定位IMA及LCA的时间)以及术后相关观察指标(术后排气时间、术后引流管渗出量以及吻合口漏和肠梗阻的发生率)的差异,从而进一步评价术前IMA三维重建技术在直肠癌D3根治术中的应用。结果:在4种IMA分支分型中,Ⅰ型和Ⅲ型是相对比较常见的类型,而Ⅳ型则比较少见;IMA的分支分型与IMA根部至LCA的直线距离有相关性。此外,与对照组相比,术前行IMA三维重建可以明显缩短腹腔镜直肠癌根治术总时间[(152.00±18.16)min vs(135.53±14.06)min, P=0.010];同时,术前IMA三维重建有助于缩短术中对IMA和LCA的定位时间(P=0.004, 0.006)、术后排气时间(P=0.029),并减少引流管渗出量(P=0.001)。结论:利用Mimics软件行IMA三维重建更便于术者准确评估患者IMA的分支类型及解剖定位,并在术中提供重要决策信息,进而明显缩短手术时间,提高直肠癌根治术的安全性。
Objective To evaluate the application value of the three-dimensional(3D) reconstruction of inferior mesenteric artery(IMA) via Mimics software in laparoscopic D3 radical resection for rectal cancer. Methods A retrospective analysis was performed on the imaging data of 71 patients with rectal cancer who underwent abdominal contrast-enhanced CT examination during June 2016 to January 2018. The 3D reconstruction of IMA which was obtained with Mimics software based on the imaging data was used to analyze the proportions of 4 different branch types of IMA, and measure the linear distance from IMA root to abdominal aortic bifurcation and to the left colon artery(LCA). Thirty patients with rectal cancer admitted to hospital from January 2018 to August 2018 were randomly divided into control group(without the 3D reconstruction of IMA before surgery) and observation group(before surgery, the surgical program was established according to the 3D reconstruction of IMA), with 15 patients in each group. A prospective analysis was performed on the differences in intraoperative and postoperative related indicators, thereby further evaluating the application of preoperative 3 D reconstruction of IMA in laparoscopic D3 radical resection for rectal cancer.The intraoperative related indicators included operation time, intraoperative blood loss, intraoperative localizations of IMA and LCA, and the postoperative related indicators included postoperative exhaust time, postoperative drainage tube exudation and the incidence of anastomotic leakage and intestinal obstruction. Results Among the 4 IMA subtypes, type Ⅰ and type Ⅲ were relatively common, while type Ⅳ was rare. The branch type of IMA was related to the linear distance from IMA root to LCA.In addition, compared with control group, the 3D reconstruction of IMA before surgery significantly shortened operation time[(152.00±18.16) min vs(135.53±14.06) min, P=0.010]. Meanwhile, preoperative 3D reconstruction of IMA was conductive to shortening the time for the localizations of IMA and LCA(P=0.004, 0.006), reducing postoperative exhaust time(P=0.029),decreasing drainage tube exudation(P=0.001). Conclusion The 3D reconstruction of IMA with Mimics software make it easier for the surgeon to accurately assess the branch types and anatomical localization of IMA and provide important decision-making information during the radical resection for rectal cancer, which can significantly shorten operation time and improve operation safety.
Objective To evaluate the application value of the three-dimensional(3D) reconstruction of inferior mesenteric artery(IMA) via Mimics software in laparoscopic D3 radical resection for rectal cancer. Methods A retrospective analysis was performed on the imaging data of 71 patients with rectal cancer who underwent abdominal contrast-enhanced CT examination during June 2016 to January 2018. The 3D reconstruction of IMA which was obtained with Mimics software based on the imaging data was used to analyze the proportions of 4 different branch types of IMA, and measure the linear distance from IMA root to abdominal aortic bifurcation and to the left colon artery(LCA). Thirty patients with rectal cancer admitted to hospital from January 2018 to August 2018 were randomly divided into control group(without the 3D reconstruction of IMA before surgery) and observation group(before surgery, the surgical program was established according to the 3D reconstruction of IMA), with 15 patients in each group. A prospective analysis was performed on the differences in intraoperative and postoperative related indicators, thereby further evaluating the application of preoperative 3 D reconstruction of IMA in laparoscopic D3 radical resection for rectal cancer.The intraoperative related indicators included operation time, intraoperative blood loss, intraoperative localizations of IMA and LCA, and the postoperative related indicators included postoperative exhaust time, postoperative drainage tube exudation and the incidence of anastomotic leakage and intestinal obstruction. Results Among the 4 IMA subtypes, type Ⅰ and type Ⅲ were relatively common, while type Ⅳ was rare. The branch type of IMA was related to the linear distance from IMA root to LCA.In addition, compared with control group, the 3D reconstruction of IMA before surgery significantly shortened operation time[(152.00±18.16) min vs(135.53±14.06) min, P=0.010]. Meanwhile, preoperative 3D reconstruction of IMA was conductive to shortening the time for the localizations of IMA and LCA(P=0.004, 0.006), reducing postoperative exhaust time(P=0.029),decreasing drainage tube exudation(P=0.001). Conclusion The 3D reconstruction of IMA with Mimics software make it easier for the surgeon to accurately assess the branch types and anatomical localization of IMA and provide important decision-making information during the radical resection for rectal cancer, which can significantly shorten operation time and improve operation safety.
引文
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[6] BUUNEN M, VELDKAMP R, HOP W C, et al. Survival after laparoscopic surgery versus open surgery for colon cancer:long-term outcome of a randomised clinical trial[J]. Lancet Oncol, 2009, 10(1):44-52.
[7] FLESHMAN J, BRANDA M, SARGENT D J, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes:the ACOSOG Z6051randomized clinical trial[J]. JAMA, 2015, 314(13):1346-1355.
[8] KE J, CAI J W, WEN X F, et al. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography:insights into rectal cancer surgery-a retrospective observational study[J]. Int J Surg, 2017, 41:106-111.
[9] LIANG J T, LAI H S. Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer[J]. Surg Endosc, 2014, 28(5):1727-1733.
[10]BRAGA M, FRASSON M, VIGNALI A, et al. Laparoscopic resection in rectal cancer patients:outcome and cost-benefit analysis[J]. Dis Colon Rectum, 2007, 50(4):464-471.
[11]SHIN D S, LEE S, PARK H S, et al. Segmentation and surface reconstruction of a cadaver heart on Mimics software[J]. Folia Morphol(Warsz), 2015, 74(3):372-377.
[12]曹桂平,张明娇,刘非,等. Arigin 3D Pro软件与Mimics软件三维重建模型的精度研究[J].中国组织工程研究, 2018, 22(15):2384-2389.CAO G P, ZHANG M J, LIU F, et al. Accuracy of three-dimensional reconstruction models using Arigin 3D Pro and Mimics software programs[J]. Journal of Clinical Rehabilitative Tissue Engineering Research, 2018, 22(15):2384-2389.
[13]ARAGHI M, SOERJOMATARAM I, JENKINS M A, et al. Global trends in colorectal cancer mortality:projections to the year 2035[J].Int J Cancer, 2019, 144(12):2992-3000.
[14]LANGE M M, BUUNEN M, VAN DE VELDE C J, et al. Level of arterial ligation in rectal cancer surgery:low tie preferred over high tie. A review[J]. Dis Colon Rectum, 2008, 51(7):1139-1145.
[15]SINDHU R, NATESH B, RAJAN R, et al. Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum:comparison of surgical and oncological outcomes with the open technique[J]. J Gastrointest Oncol, 2017, 8(5):850-857.
[16]BONNET S, BERGER A, HENTATI N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery:impact on the gain in colon length and implications on the feasibility of anastomoses[J]. Dis Colon Rectum, 2012, 55(5):515-521.
[17]YAMAMOTO M, OKUDA J, TANAKA K, et al. Oncological impact of laparoscopic lymphadenectomy with preservation of the left colic artery for advanced sigmoid and rectosigmoid colon cancer[J]. Dig Surg, 2014, 31(6):452-458.
[18]SAKORAFAS G H, ZOUROS E, PEROS G. Applied vascular anatomy of the colon and rectum:clinical implications for the surgical oncologist[J]. Surg Oncol, 2006, 15(4):243-255.
[19]NANO M, DAL CORSO H, FERRONATO M, et al. Ligation of the inferior mesenteric artery in the surgery of rectal cancer:anatomical considerations[J]. Dig Surg, 2004, 21(2):123-126.
[2] SIEGEL R L, MILLER K D, FEDEWA S A, et al. Colorectal cancer statistics, 2017[J]. CA Cancer J Clin, 2017, 67(3):177-193.
[3] BRENNER H, KLOOR M, POX C P. Colorectal cancer[J]. Lancet,2014, 383(9927):1490-1502.
[4] POON J T, LAW W L. Laparoscopic resection for rectal cancer:a review[J]. Ann Surg Oncol, 2009, 16(11):3038-3047.
[5] JAYNE D G, THORPE H C, COPELAND J, et al. Five-year followup of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer[J].Br J Surg, 2010, 97(11):1638-1645.
[6] BUUNEN M, VELDKAMP R, HOP W C, et al. Survival after laparoscopic surgery versus open surgery for colon cancer:long-term outcome of a randomised clinical trial[J]. Lancet Oncol, 2009, 10(1):44-52.
[7] FLESHMAN J, BRANDA M, SARGENT D J, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes:the ACOSOG Z6051randomized clinical trial[J]. JAMA, 2015, 314(13):1346-1355.
[8] KE J, CAI J W, WEN X F, et al. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography:insights into rectal cancer surgery-a retrospective observational study[J]. Int J Surg, 2017, 41:106-111.
[9] LIANG J T, LAI H S. Surgical technique of robotic D3 lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery and autonomic nerves for the treatment of distal rectal cancer[J]. Surg Endosc, 2014, 28(5):1727-1733.
[10]BRAGA M, FRASSON M, VIGNALI A, et al. Laparoscopic resection in rectal cancer patients:outcome and cost-benefit analysis[J]. Dis Colon Rectum, 2007, 50(4):464-471.
[11]SHIN D S, LEE S, PARK H S, et al. Segmentation and surface reconstruction of a cadaver heart on Mimics software[J]. Folia Morphol(Warsz), 2015, 74(3):372-377.
[12]曹桂平,张明娇,刘非,等. Arigin 3D Pro软件与Mimics软件三维重建模型的精度研究[J].中国组织工程研究, 2018, 22(15):2384-2389.CAO G P, ZHANG M J, LIU F, et al. Accuracy of three-dimensional reconstruction models using Arigin 3D Pro and Mimics software programs[J]. Journal of Clinical Rehabilitative Tissue Engineering Research, 2018, 22(15):2384-2389.
[13]ARAGHI M, SOERJOMATARAM I, JENKINS M A, et al. Global trends in colorectal cancer mortality:projections to the year 2035[J].Int J Cancer, 2019, 144(12):2992-3000.
[14]LANGE M M, BUUNEN M, VAN DE VELDE C J, et al. Level of arterial ligation in rectal cancer surgery:low tie preferred over high tie. A review[J]. Dis Colon Rectum, 2008, 51(7):1139-1145.
[15]SINDHU R, NATESH B, RAJAN R, et al. Low-tie IMA and selective D3 lymph node sampling in laparoscopic rectal resection for carcinoma rectum:comparison of surgical and oncological outcomes with the open technique[J]. J Gastrointest Oncol, 2017, 8(5):850-857.
[16]BONNET S, BERGER A, HENTATI N, et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery:impact on the gain in colon length and implications on the feasibility of anastomoses[J]. Dis Colon Rectum, 2012, 55(5):515-521.
[17]YAMAMOTO M, OKUDA J, TANAKA K, et al. Oncological impact of laparoscopic lymphadenectomy with preservation of the left colic artery for advanced sigmoid and rectosigmoid colon cancer[J]. Dig Surg, 2014, 31(6):452-458.
[18]SAKORAFAS G H, ZOUROS E, PEROS G. Applied vascular anatomy of the colon and rectum:clinical implications for the surgical oncologist[J]. Surg Oncol, 2006, 15(4):243-255.
[19]NANO M, DAL CORSO H, FERRONATO M, et al. Ligation of the inferior mesenteric artery in the surgery of rectal cancer:anatomical considerations[J]. Dig Surg, 2004, 21(2):123-126.
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