| Objective: Through the three-dimensional visualization technology,the location of pancreatic tumor in the abdominal cavity was observed and analyzed,as well as the invasion degree of peripancreatic blood vessels and tissues,the resectability of the tumor was accurately evaluated,and the difficulty part of surgical procedures were analyzed through the simulated operation to achieve the precise surgical treatment of pancreatic tumor.Method: Data from 52 consecutive patients who underwent laparoscopic pancreaticoduodenectomy at The First Affiliated Hospital of Wannan Medical College between June 2017 and June 2019 were reviewed.Among them,22 patients underwent routine enhanced CT and MRCP examination,as well as threedimensional visual reconstruction and simulated surgery(experimental group),another 30 patients only underwent routine enhanced CT examination and MRCP examination(control group).The differences of the two groups in gender,age,BMI,basic diseases,ASA classification,operation time,intraoperative blood loss,R0 resection rate,postoperative pancreatic fistula,postoperative biliary leakage,postoperative delayed gastric empties and postoperative bleeding were compared,the experimental group three-dimensional model results were observed,and the clinical value of three-dimensional visualization technology in pancreatic tumor resection was evaluated.Results: The preoperative age of the two groups was 63.18±8.67 y in the experimental group and 62.59±7.59 y in the control group(P value >0.05).Gender: 13 males and 9 females in the experimental group,19 males and 11 females in the control group(P value >0.05).BMI: 20.21±2.60 kg/m2 in the experimental group and 20.79±3.75 kg/m2 in the control group(P value >0.05).8 patients had cardiovascular disease,3 patients had diabetes,and 0 patient had undergone abdominal surgery in the experimental group,12 patients had cardiovascular disease,2 patients had diabetes,and 2 patients had undergone abdominal surgery in the control group(P value >0.05).For the ASA classification,13,7 and 2 patients were classified as ASA I,ASA III and ASA III,respectively,in the experimental group,17,12 and 1 patients were classified as ASA I,ASA II and ASA III,respectively,in the control group(P value >0.05).There was no significant difference between the two groups before operation,thus,the data of two groups can be compared.In the experimental group,the volume of the tumor was measured: the minimum volume was 2.00 ml,the maximum volume was 30.62 ml,the median volume was 12.00 ml,and the mean and standard deviation volume was 10.95±7.73 ml.The diameter of pancreatic duct was measured,the minimum value was 2.85 mm,the maximum value was 10.60 mm,the median value was 6.50 mm,and the mean and standard deviation value was 4.58±1.73 mm.The minimum distance from the root of common hepatic artery to the root of gastroduodenal artery was 14.88 mm,the maximum was 42.00 mm,the median was 25.28 mm,and the mean standard and deviation was 24.05±6.18 mm.The minimum distance from the lower margin of the pancreatic duct to the lower margin of the pancreas was 6.4mm,the maximum was 19.53 mm,the median was 14.30 mm,and the mean standard and deviation was 13.59±3.34 mm.The reconstruction rate of celiac trunk,common hepatic artery,proper hepatic artery,splenic artery,splenic vein,gastroduodenal artery,superior mesenteric artery,portal vein,superior mesenteric vein was 100%,the reconstruction rate of dorsal pancreatic artery was 45.4%,the reconstruction rates of superior pancreaticoduodenal artery and inferior pancreaticoduodenal artery were 50% and 36.4%,respectively.Intraoperative time: 361.82±84.27 min in the experimental group and 396.33±54.36 min in the control group(P value>0.05);Intraoperative bleeding volume: 301.82±100.93 ml in the experimental group and 432.67±283.35 ml in the control group(P value<0.05),the difference was statistically significant,indicating that the intraoperative bleeding volume was higher in the control group;R0 resection rate was 100% in the experimental group and 93.33% in the control group(P value>0.05).Postoperative pancreatic fistula: there were 15 cases of biochemical fistula in the experimental group,6 cases of grade B pancreatic fistula,1 case of grade C pancreatic fistula,21 cases of biochemical fistula in the control group,8 cases of grade B pancreatic fistula,1 case of grade C pancreatic fistula(P value>0.05).Postoperative biliary leakage: 0 patients in the experimental group,2 patients in the control group(P value>0.05);Postoperative delayed gastric emptying: 1 patient in the experimental group,0 patient in the control group(P value>0.05);Postoperative bleeding: 1 patient in the experimental group and 1 patient in the control group(P value>0.05).Conclusion: Preoperative evaluation and simulated operation of pancreatic tumor by three-dimensional visualization technology can reduce intraoperative blood loss,which has certain clinical application value... |
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