Applied Research Of Three-dimensional Visualization Technology In Preoperative Evaluation Of Larger Adrenal Tumors

Objective:To study the effect of three-dimensional visualization(3DV)technology applied to preoperative evaluation of larger adrenal tumorsMethods:A total of 51 patients who underwent laparoscopic surgery for large adrenal tumors(maximum tumor diameter?4cm)between January 2017 and June 2019 in the department of Urology,the First Affiliated Hospital of Kunming Medical University.Among them,17 were preoperatively evaluated by 3DV images,and 34 were preoperatively evaluated by computerized tomography(CT).? A total of 5 urology specialists and doctors were invited.Provided enhanced CT images and 3DV images of 17 patients in the 3DV group for the invited 5 doctors to read the film to evaluate the difficulty of surgery and postoperative complications,and recorded the time each doctor used to evaluate each image data.The time of evaluating 3DV image will be compared with that of CT image.?After the invited doctors finished all the readings,the two preoperative evaluation methods of viewing 3DV images and CT images were scored from five aspects according to the scoring standard of the Likert Scale.And compared the scores of the two methods on each aspect.?Collected data of 51 patients in two groups:pathological diagnosis,age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,New York Heart Association(NYHA)heart function grade,with or without hypertension,with or without diabetes,tumor size(maximum tumor diameter),tumor location(left/right),laparoscopic surgical approach(transabdominal/transperitoneal),the operation time,intraoperative blood loss,hospital stay after the operation,and complications after the operation were compared.?Collected the preoperative heart rate(HR)and blood pressure of patients with adrenal pheochromocytoma(PHEO),togther with the maximum and minimum values of HR,systolic blood pressure(SBP),and diastolic blood pressure(DBP)during the surgery,and compared them.SPSS26.0 was used to analyze the data.Results:1.All the participating doctors used 3DV images to evaluate the difficulty and postoperative complications of laparoscopic surgery for larger adrenal tumors,and the time was shorter than that of CT images.The difference was statistically significant(P<0.05).2.The participating doctors used the Likert Scale to score the two preoperative evaluation methods of 3DV images and CT images.The 3DV images and CT images were relatively consistent in Q1(judging whether there is a surgical indication)and Q2(locating the tumor location),and the differences were not statistically significant(P>0.05).The doctors rated 3DV images higher than CT images in Q3(judgment of tumor complexity),Q4(guidance on the choice of surgery),and Q5(reduction of surgical complications),and the differences were statistically significant(P<0.05).3.Patients in the 3DV group and CT group in the age,gender,BMI,ASA grade,NYHA cardiac function grade,the proportion of hypertension,the proportion of diabetes,tumor size(largest diameter of tumor),tumor location(left/right),laparoscopic surgical approach(transabdominal/transperitoneal),intraoperative blood loss,hospital stay after surgery,postoperative complications,these differences were not statistically significant(P>0.05).The operation time of the patients in the 3DV group was shorter than that in the CT group(P<0.05),and the difference was statistically significant.4.There was no statistically significant difference in the highest and lowest values of intraoperative SBP,DBP,and HR of adrenal PHEO patients in the 3DV group and CT group(P>0.05).The fluctuation range of SBP and DBP in adrenal PHEO patients in the 3DV group was smaller than that in the CT group,and the difference was statistically significant(P<0.05).Conclusions:1.When evaluating the difficulty and complication of laparoscopic surgery for larger adrenal tumors,3DV images were more efficient and rapid than CT images.2.The use of 3DV for preoperative evaluation of larger adrenal tumors had given doctors greater confidence in surgery.3.After 3DV was used for the preoperative anatomical evaluation of patients with larger adrenal tumors,the relationship between the tumor and the surrounding large blood vessels,tissues,and organs will be more clearly understood,which can improve the operation efficiency and shorten the operation time.4.The preoperative evaluation of larger adrenal pheochromocytoma through 3DV can shorten the operation time and reduce the compression of adrenal pheochromocytoma during the operation.At the same time,the position of most central adrenal veins can be displayed by 3DV images,so that the surgeon can find and ligate the central adrenal vein faster to prevent more catecholamines from entering the bloodstream,thereby reducing blood pressure fluctuations.5.As a new image processing technology,3DV is not covered by medical insurance reimbursement.Therefore,patients need to pay 2-3thousands yuan at their own expense.