三维可视技术指导腹腔镜胰十二指肠切除治疗胰头癌19例体会

目的评价三维可视化技术指导腹腔镜十二指肠切除治疗胰头癌的可行性与临床价值。 方法回顾性选取2017年1月至2018年8月收治并确诊的19例胰头癌患者的临床资料。其中男11例，女8例；年龄23～79岁，平均(54.3±14.2)岁。其中胰腺导管腺癌15例，胰腺黏液腺癌2例，乳头状癌2例。对患者进行定位二维CT成像，采用三维可视化技术重建二维CT图像，进行术前评估、三维可视化可切除性评估临床分型及其可切除性，并将其与手术中发现进行比较。 结果本组19例患者均经手术探查证实为胰头癌。经三维可视化重建后，19例患者中，可切除性评估为Ⅰ型者4例、Ⅱ型7例、Ⅲ型l例、Ⅳ型3例、Ⅴ型4例，8例评估后行胰腺肿瘤切除；血管解剖变异2例，清晰显示可疑的淋巴结11例，三维重建肿瘤的解剖关系与术中所见相符。 结论三维可视化技术有助于指导胰腺肿瘤患者进行术前可切除性评估，明确肿瘤大小、解剖学变异、肿大淋巴结等，具有一定的优势，值得在临床中推广使用。

Laparoscopic pancreaticoduodenectomy for pancreatic head cancer guided by three-dimensional visual technique, 19 cases of report

ObjectiveTo evaluate the feasibility and clinical value of laparoscopic pancreaticoduodenectomy in the treatment of pancreatic head cancer. MethodsFrom January 2017 to August 2018, clinical data of 19 patients with pancreatic head cancer were retrospectively analyzed, including 11 male cases and 8 female cases, with average age of (54.3±14.2) years ranging from 23 to 79 years. There were 15 cases of pancreatic ductal adenocarcinoma, 2 cases of pancreatic mucinous adenocarcinoma and 2 cases of papillary carcinoma. The localization two-dimensional CT imaging were performed, and the three-dimensional visualization technique were used to reconstruct the two-dimensional CT images. The preoperative evaluation was carried out. The clinical classification and resectability of the patients were evaluated by three-dimensional visualization and the results were compared after surgery. ResultsAll of 19 cases were proved to be pancreatic head carcinoma by surgical exploration. In 19 patients with 3D visual reconstruction, the resectability was assessed as 4 cases of type I, 7 cases of type Ⅱ, 1 case of type Ⅲ, 3 cases of type Ⅳ and 4 cases of type Ⅴ, pancreatic tumor resection were performed in 8 cases, with 2 cases of vascular anatomic variation. 11 cases of suspected lymph nodes. The anatomical relationship of the three-dimensional reconstruction tumor was approximately consistent with surgical exploration. ConclusionThree-dimensional visualization is helpful to evaluate the resectability of pancreatic tumor patients before operation, to determine tumor size, anatomic variation, enlarged lymph nodes, and so on. It is worth popularizing in clinic.