外科理论与实践

外科理论与实践 ›› 2019, Vol. 24 ›› Issue (06): 512-516.doi: 10.16139/j.1007-9610.2019.06.009

• 论著 • 上一篇    下一篇

三维数字化技术在单通道腔镜甲状旁腺手术中的应用

陈灵勰1, 宣明2,*, 丁昊2, 张永昶2, 陈诚2, 匡洁1, 严佶祺1, 邱伟华1,2, 谈坚2   

  1. 1.上海交通大学医学院附属瑞金医院外科,上海 200025;
    2.民航上海医院-瑞金医院古北分院普外科,上海 200336
  • 收稿日期:2019-06-11 出版日期:2019-11-25 发布日期:2019-12-25
  • 通讯作者: 谈坚,E-mail: tjwpp687@sina.com
  • 作者简介:* 共同第一作者
  • 基金资助:
    国家自然科学基金（81772558）; 上海市长宁区医疗卫生科研专项课题（CNKW2017Y30）

3-dimentional digital technique in single-site endoscopic parathyroidectomy

CHEN Lingxie1, XUAN Ming2, DING Hao2, ZHANG Yongchang2, CHEN Cheng2, KUANG Jie1, YAN Jiqi1, QIU Weihua1,2, TAN Jian2   

  1. 1. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
    2. Department of General Surgery, Shanghai Hospital of Civil Aviation-Gubei Branch of Ruijin Hospital, Shanghai 200336, China
  • Received:2019-06-11 Online:2019-11-25 Published:2019-12-25

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摘要： 目的:探讨在精准外科理念下运用3D可视化模型对经乳晕单通道腔镜甲状旁腺切除术（TASSEP）行数字化手术设计的价值。方法:回顾性分析2017年4月至2018年12月行TASSEP的12例原发性甲状旁腺功能亢进（PHPT）病人的临床资料。所有病人于术前完成病灶精准定位诊断。基于超薄层CT扫描图像构建3D可视化模型,行数字化手术设计。检测手术前、后血清甲状旁腺素、血钙水平。观察并发症发生,术后随访病人美容满意度及生化治愈情况。结果:12例均按照术前数字化手术设计成功完成TASSEP,无中转开放手术,无术后并发症发生。平均手术时间（97.1±30.3） min,术中出血量（18.7±2.8） mL,病人美容满意度评分中位数8（7~10）分。术后随访6个月,所有病人甲状旁腺素与血钙水平均保持正常,无复发。结论:运用3D可视化模型进行PHPT数字化手术设计,有效提高手术安全性和效果,并为病人提供良好的美容效果。

关键词: 三维数字化技术, 单通道腔镜, 甲状旁腺

Abstract: Objective To evaluate the feasibility using 3-dimentional (3D) virtual model in digital surgery design of trans-areola single-site endoscopic parathyroidectomy (TASSEP) based on principle of precise surgery. Methods A retrospective analysis was performed on the clinical data of 12 patients with primary hyperparathyroidism (PHPT) who received TASSEP from April 2017 to December 2018. All patients had preoperative localization with ultrathin CT scan to build 3D virtual models for precise surgical design. Parathyroid hormone and blood calcium were detected preoperatively and postoperatively. The complications were recorded after surgery. Cosmetic and biochemical results were followed up. Results TASSEP was completed in all 12 patients successfully according to the preoperative digital surgery without conversion to open surgery. No complication was present after surgery. The surgical time was (97.1±30.3) min with blood loss (18.7±2.8) mL and cosmetic satisfactory median score 8 (7-10). The parathyroid hormone and serum calcium levels were normal at 6 month postoperative follow-up without recurrence. Conclusions 3D virtual model for digital surgery design of PHPT would be used for safety and efficiency of surgery and cosmetic outcomes.

Key words: 3-dimentional digital technique, Single-site endoscopy, Parathyroid

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