三维打印用于保留左结肠动脉的腹腔镜直肠癌手术的术前演练和术中导航。

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY World Journal of Gastrointestinal Surgery Pub Date : 2024-10-27 DOI:10.4240/wjgs.v16.i10.3104
Zong-Xian Zhao, Zong-Ju Hu, Run-Dong Yao, Xin-Yu Su, Shu Zhu, Jie Sun, Yuan Yao
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引用次数: 0

摘要

背景:先前的研究表明,在腹腔镜直肠癌(RC)根治性切除术中保留左结肠动脉(LCA)可减少吻合口漏(AL)的发生,同时不影响肿瘤治疗效果。然而,肠系膜下动脉(IMA)和 LCA 分支的解剖结构变化给手术带来了巨大挑战。在本研究中,我们展示了新型三维(3D)打印 IMA 模型,该模型旨在促进术前演练和术中导航,以分析其对手术安全性的影响。目的:研究三维 IMA 模型对在 RC 手术中保留 LCA 的影响:我们回顾性收集了2022年1月至2024年5月在阜阳市人民医院接受腹腔镜根治性切除术的RC患者的临床资料。将患者分为3D打印组和对照组,对围手术期特征进行统计分析:结果:3D打印观察组有72名患者,对照组有68名患者。手术时间(174.5 ± 38.2 分钟 vs 198.5 ± 49.6 分钟,P = 0.002)、术中失血量(43.9 ± 31.3 mL vs 58.2 ± 30.8 mL,P = 0.005)、住院时间(13.1 ± 3.1 天 vs 15.9 ± 5.6 天,P < 0.001)、术后恢复时间(8.6 ± 2.6 天 vs 10.5 ± 4.9 天,P = 0.007)和术后并发症发生率(P < 0.05)均显著低于观察组:结论:在腹腔镜RC根治性切除术中使用3D打印的IMA模型可以帮助外科医生在术前了解LCA的解剖结构,从而减少术中出血,缩短手术时间,具有更好的临床应用潜力。
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Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation.

Background: Prior studies have shown that preserving the left colic artery (LCA) during laparoscopic radical resection for rectal cancer (RC) can reduce the occurrence of anastomotic leakage (AL), without compromising oncological outcomes. However, anatomical variations in the branches of the inferior mesenteric artery (IMA) and LCA present significant surgical challenges. In this study, we present our novel three dimensional (3D) printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.

Aim: To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.

Methods: We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People's Hospital. Patients were divided into the 3D printing and control groups for statistical analysis of perioperative characteristics.

Results: The 3D printing observation group comprised of 72 patients, while the control group comprised 68 patients. The operation time (174.5 ± 38.2 minutes vs 198.5 ± 49.6 minutes, P = 0.002), intraoperative blood loss (43.9 ± 31.3 mL vs 58.2 ± 30.8 mL, P = 0.005), duration of hospitalization (13.1 ± 3.1 days vs 15.9 ± 5.6 days, P < 0.001), postoperative recovery time (8.6 ± 2.6 days vs 10.5 ± 4.9 days, P = 0.007), and the postoperative complication rate (P < 0.05) were all significantly lower in the observation group.

Conclusion: Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively, thereby reducing intraoperative bleeding and shortening operating time, demonstrating better clinical application potential.

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