交互式医学图像控制系统软件三维重建在肺腺癌复杂肺段切除术中的应用

宋明磊; 曹富民; 邢晓英; 高立平; 井洪家

doi:10.16766/j.cnki.issn.1674-4152.002442

交互式医学图像控制系统软件三维重建在肺腺癌复杂肺段切除术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002442

1.
河北医科大学第四医院胸外科，河北石家庄 050011
2.
河北医科大学第二医院全科医疗科, 河北石家庄 050011
3.
承德市中心医院心胸外科，河北承德 067000

基金项目:

河北省医学科学研究重点课题 20180554

详细信息

通讯作者:
宋明磊，E-mail：songml1705@163.com

中图分类号: R734.2 R730.56
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出版历程
- 收稿日期: 2021-08-11
- 网络出版日期: 2022-09-05

Application of MIMICS software three-dimensional reconstruction in complex segmental resection of lung adenocarcinoma

1.
Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China

摘要

摘要: 目的评价交互式医学图像控制系统(MIMICS)软件行三维重建联合胸腔镜在肺腺癌复杂肺段切除术中的应用价值。方法以2016年1月—2017年6月在河北医科大学第四医院进行单纯胸腔镜肺段切除术的42例患者为对照组，以2017年7月—2018年7月期间行MIMICS软件三维重建联合胸腔镜肺段切除术的48例患者为观察组。比较2组围手术期临床指标、手术并发症；比较术前和拔除胸腔引流管后2组肺功能指标，包括1 s用力呼气容积(FEV₁)、用力肺活量(FVC)、每分钟最大通气量(MVV)。结果 2组患者病灶数量、结节性质差异无统计学意义(均P＞0.05)，观察组并发症发生率(10.42%，5/48)显著低于对照组(28.57%，12/42，P＜0.05)。观察组手术时间、术中出血量、术后胸管留置时间、术后住院时间显著短于对照组(均P＜0.05)。2组术前FEV₁、FVC、MVV差异无统计学意义(均P>0.05)；拔除胸腔引流管后，2组患者肺功能均显著低于术前，但观察组FEV₁、FVC、MVV显著高于对照组[(1.67±0.52) L vs. (1.38±0.69) L, (1.73±0.64) L vs. (1.48±0.51) L, (54.27±7.14) L/min vs. (50.36±6.08) L/min, 均P < 0.05]。结论对于行复杂肺段切除术的肺腺癌患者，采用MIMICS软件在术前进行三维重建有利于在术中分辨肺部解剖结构，确定结节位置，有利于提高手术准确性，缩短手术时间，减少并发症，减轻手术对肺功能的损伤，利于术后康复。
- 图像控制系统 /
- 电视胸腔镜 /
- 三维重建 /
- 肺段切除术 /
- 肺腺癌 /
- 肺功能
Abstract: Objective To evaluate the clinical value of Materialise's interactive medical image control system (MIMICS) software 3D reconstruction combined with thoracoscopy in complex segmental resection of lung adenocarcinoma. Methods The control group comprised 42 patients who underwent thoracoscopic segmentectomy in our hospital from January 2016 to June 2017. The observation group was composed of 48 patients who underwent MIMICS software 3D reconstruction combined with thoracoscopic segmentectomy in the Fourth Hospital of Hebei Medical University from July 2017 to July 2018. The perioperative clinical parameters and operative complications were compared between the two groups. The pulmonary function indexes before operation and after removal of thoracic drainage tube were compared, including forced expiratory volume in one second (FEV₁), forced vital capacity (FVC) and maximum voluntary ventilation (MVV) per minute. Results No significant difference was found in the number of lesions and the nature of nodules between the two groups (P>0.05). The incidence of complications in the observation group (10.42%, 5/48) was significantly lower than that in the control group (28.57%, 12/42, P < 0.05). The average operation time, average intraoperative bleeding volume, average post-operative thoracic tube indwelling time and average post-operative hospital stay in the observation group were significantly shorter than those in the control group (all P < 0.05). There was no significant difference in FEV₁, FVC and MVV between the two groups before the operation (all P>0.05). After removal of the thoracic drainage tube, the pulmonary function indexes of the two groups were significantly lower than those before the operation. The FEV₁, FVC and MVV of the observation group were significantly higher than those of the control group [(1.67±0.52) L vs. (1.38±0.69) L, (1.73±0.64) L vs. (1.48±0.51) L, (54.27±7.14) L/min vs. (50.36±6.08) L/min, all P < 0.05)]. Conclusion For patients with pulmonary adenocarcinoma undergoing complex segmental resection, using MIMICS software 3D reconstruction before operation can help distinguish the anatomical structure of the lungs, determine the location of the nodules, improve the accuracy of the operation, shorten the operation time, reduce complications, reduce the damage of the lung function caused by the operation and facilitate rehabilitation after the operation.
- Image control system /
- Video-assisted thoracoscopy /
- Three-dimensional reconstruction /
- Segmentectomy /
- Lung adenocarcinoma /
- Lung function

HTML全文

图 1 术前三维重建与术中解剖对照

注：患者男性，65岁，肺腺癌早期。A为CT平扫水平面图像，可见结节位于左上肺后段；B为MIMICS三维重建显示肺动静脉、支气管与肺结节图像；C为MIMICS三维重建20%透明度下肺段/亚段划分(不同颜色标记不同肺段)；D为规划手术路径，模拟切除肺段/亚段；E、F为三维重建下胸腔镜肺段切除显示3支上肺静脉；G、H分离显露A2b、A4a及B4、B3分叉；I、J为离断后显露B1、B2、B4。

Figure 1. Comparison of preoperative three-dimensional reconstruction and intraoperative anatomy

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表 1 2组行肺段切除术患者围手术期临床指标比较(x±s)

Table 1. Comparison of perioperative clinical indicators between two groups of patients undergoing segmentectomy(x±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后胸管留置时间(d)	住院时间(d)
对照组	42	128.36±11.29	96.25±14.17	7.96±1.61	8.65±1.43
观察组	48	115.36±8.79	88.64±10.92	7.11±1.45	7.34±1.11
t值		6.133	2.872	2.635	4.885
P值		< 0.001	0.005	0.010	< 0.001

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表 2 2组行肺段切除术患者切除肺段分布(例)

Table 2. Distribution of resected lung segments in two groups of patients undergoing segmentectomy (cases)

切除肺段	对照组(42例)	观察组(48例)
右上肺分段
S1	0	3
S2	2	3
S3	4	5
S1+S2	5	4
右基底分段
S7+S8	3	3
S9+S10	5(1例术中转S8+S9+S10)	6
S6+S9+S10	1	2
左上肺固有段分段
S1+2(a)(亚段)	2(1例术中转S1+S2)	6
S1+2(c)(亚段)	0	3
S3	7	1
S1+S2	5(2例术中转S1+S2+S3)	1
S1+S2+S3	4	3
左侧基底分段
S8	1	6
S9+S10	3(1例术中转S7+S8+S9+S10)	2

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表 3 2组行肺段切除术患者肺功能指标对比(x±s)

Table 3. Comparison of pulmonary function indexes between two groups of patients undergoing segmentectomy(x±s)

组别	例数	FEV₁(L)		FVC(L)		MVV(L/min)
组别	例数	术前	拔除胸腹引流管后	术前	拔除胸腹引流管后	术前	拔除胸腹引流管后
对照组	42	2.78±0.92	1.38±0.69^a	3.06±0.72	1.48±0.51^a	81.29±4.75	50.36±6.08^a
观察组	48	2.85±0.97	1.67±0.52^a	2.94±0.66	1.73±0.64^a	79.76±5.22	54.27±7.14^a
t值		0.350	2.268	0.825	2.029	1.446	2.776
P值		0.727	0.026	0.412	0.045	0.152	0.007
注：与同组术前比较，^aP＜0.05。

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