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

  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。 

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

  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.