能谱CT三维重建技术在胃癌根治术中胰腺上区淋巴结清扫中的应用

目的 探讨能谱CT三维重建技术在胃癌根治术中胰腺上区淋巴结清扫中的实用性与准确性。方法 选取2021年1月至2022年10月于包头医学院第二附属医院行腹腔镜胃癌根治术的80例胃癌患者,根据随机数字表法将其分成对照组和三维组,每组各40例。三维组患者采用容积重建技术对胰腺上区组织器官进行三维重建,依据三维重建结果确定手术方案,并与术中病变实际情况进行对比。对照组患者术前不进行三维重建,手术医生在参考CT影像学资料后直接进行手术。比较两组患者的手术时间、术中出血量、术中淋巴结清扫个数及术后并发症情况。结果 所有患者均顺利完成手术。三维组患者成功完成三维重建,术前胰腺上区三维重建和术中实际情况完全一致,三维重建准确性达100%。三维组患者的手术时间短于对照组,术中出血量少于对照组,术中清扫淋巴结总数和清扫胰腺上区淋巴结数均多于对照组（P<0.05）。两组患者的术后并发症发生率比较差异无统计学意义（P>0.05）。结论 术前应用能谱CT三维重建技术可直观、准确地定位病灶,有助于实施胰腺上区淋巴结的精确解剖,并提高手术的质量和安全性,对手术具有指导意义。

Application of spectral CT three-dimensional reconstruction technique in supra-pancreatic lymph node dissection during radical gastrectomy

Objective To explore the utility and accuracy of spectral CT 3D recombination technique in supra-pancreatic lymph node dissection during radical gastrectomy. Methods A total of 80 patients with gastric cancer who underwent laparoscopic radical gastrectomy in the Second Affiliated Hospital of Baotou Medical College from January 2021 to October 2022 were selected, and they were divided into control group and 3D group according to random number table method, with 40 cases in each group. The patients in 3D group underwent 3D reconstruction of the tissues and organs in supra-pancreatic using volumetric reconstruction technology, and the surgical plan was determined based on the 3D reconstruction results and compared with the actual situation of the lesions during the operation. Patients in control group did not undergo preoperative 3D reconstruction, and the surgeon directly performed surgery after referring to the CT imaging data. The operation time, intraoperative bleeding, number of intraoperative lymph node dissection and postoperative complications of two groups were compared. Results All patients successfully completed the surgery. Patients in 3D group successfully completed 3D reconstruction, and the results of preoperative 3D reconstruction of the supra-pancreatic region and the actual intraoperative situation were completely consistent with each other, and the accuracy of 3D reconstruction was 100%. The operation time in 3D group was shorter than that in control group, the intraoperative bleeding was less than that in control group, and the total number of lymph nodes dissection and the number of lymph nodes dissection from supra-pancreatic region were more than those in control group during the operation (P<0.05). There was no statistically significant difference in the postoperative complication rates between the two groups (P>0.05). Conclusion The preoperative application of spectral CT 3D reconstruction technique can visually and accurately locate the lesion, contribute to the accurate anatomy of supra-pancreatic lymph nodes, and improve the quality and safety of surgery, which has guiding significance for surgery.