| Background:Three-dimensional reconstruction models(Three-dimensional Recontruction,3D)are popular in minimally invasive surgery,and thoracic surgery is gradually developing technology application.Three-dimensional reconstruction technology refers to the process of transforming two-dimensional images to three-dimensional visualization models by the computer softwares.These models can clearly display tumor characteristics,relationships with blood vessels and adjacent anatomy,which have important guiding significance for disease diagnosis,preoperative planning and surgical process.Three-dimensional reconstruction models are usually used in the diagnosis and treatment of lung surgery diseases,which can effectively increase the safety of surgery,but there are few reports in the field of esophageal surgery.Object:This study combines three-dimensional reconstruction model with thoracic laparoscopic radical esophageal cancer surgery,analyzing the relevant diagnostic indicators,surgical-related indicators,and characteristics of reconstruction model of three-dimensional reconstruction before surgery.And this study explores the clinical application value of three-dimensional reconstruction model in minimally invasive radical resection of esophageal cancer.Method:This study is a randomized controlled study.Patients who are diagnosed as esophageal squamous cell carcinoma through gastroscopy pathology from the First Affiliated Hospital of Henan University from December 2018 to December 2019 were selected.Inclusion criteria: 1.Complete preoperative gastroscopy and a clear diagnosis of esophageal squamous cell carcinoma;2.Patients aged 18-80 who are informed of the study and they agree to cooperate with the study and sign informed consent;3.All patients meet the indications for esophageal cancer surgery and undergo radical thoracic laparoscopy combined with radical esophageal cancer surgery;4.Patients undergo enhanced CT of the chest and upper abdomen before surgery and other imaging data are complete;Exclusion criteria: 1.Patients who are allergic to related drugs and contrast agents;2.Patients who have postoperative pathological results of sarcoma,or tumors are located at the junction of the esophagus and stomach;3.Patients who cannot cooperate actively.The 42 patients are randomly divided into two groups by using the telephone division method.The 21 patients in the experimental group are preoperatively treated with 3D reconstruction models and other auxiliary examinations made by Mimics for preoperative planning and intraoperative guidance.Other 21 patients in the control group are treated with enhanced CT and the same auxiliary examinations as the experimental group for preoperative planning and intraoperative guidance.We collected the relevant preoperative diagnostic indicators and intraoperative surgical indicators for comparative analysis to explore the clinical application value of the three-dimensional reconstruction models in esophageal surgery.Result:First,the results of preoperative reconstruction1.All patients underwent preoperative gastroscopy.38 cases passed the endoscopy,4 cases failed.The length of the lesion measured by group gastroscopy was 3.684 ± 1.244 cm,and the pathological length after surgery was 3.508 ± 1.186 cm.The three-dimensional reconstruction of the experimental group measured the lesion.The length was 3.651 ± 1.959 cm,and the postoperative pathological length was 3.881 ± 2.018 cm.Preoperative three-dimensional reconstruction,gastroscopy and postoperative pathological measurement results,and preoperative three-dimensional reconstruction and preoperative gastroscopy measurement results were statistically significant.2.21 patients with esophageal cancer in the experimental group were pathologically diagnosed as T1 stage 2 cases,T2 stage 9 cases,and T3 stage 10 after operation.Among them,3 cases,9 cases,and 9 cases were diagnosed as T1 stage,T2 stage,and T3 stage by 3D reconstruction before surgery with accuracy of 50%,66.7%,and 70% respectively.The total accuracy of all patients was 66.7%.3.21 patients with esophageal cancer in the experimental group were labeled with 133 lymph nodes through a three-dimensional reconstruction model,of which 13 were positive and 120 were negative.Compared with the postoperative pathological results,a total of 6 positive lymph nodes and 106 negative lymph nodes were consistent with the pathological results.The accuracy of 3D reconstruction in terms of lymph node metastasis was 84.2%,the sensitivity was 30%,and the specificity was 93.8%Second,the results related to surgery1.The study objects were 42 cases,21 cases in the experimental group and 21 cases in the control group.There was no statistical difference in gender,age,body mass index,lesion location and intraoperative anastomosis location between the two groups.2.The results of surgery-related indicators in the experimental group and the control group showed that the operation time(264.52 ± 54.43 / 339.26 ± 78.08 min,P = 0.001),intraoperative blood loss(148.81 ± 43.64 / 200 ± 72.46,P = 0.008),postoperative 24-hour drainage(188.1 ± 59.45 / 262.38 ± 60.91,P = 0.000),number of lymph node dissections(7.67 ± 1.91 / 6.24 ± 1.67,P = 0.014),patient compliance(70 ± 15.49 / 53.81 ± 14.93,P = 0.014,P = 0.001)were statistically different.3.Complications: No complications occurred in the experimental group.One patient in the control group developed an anastomotic neck fistula,which was cured after conservative treatment.One case of thoracic anastomotic fistula was cured after endoscopic anastomotic fistula treatment.One case had a pulmonary infection,which was cured after anti-infective treatment.Conclusion:1.The three-dimensional reconstruction model can show the anatomical structure and adjacent structure of the esophagus and tumor in detail.The three-dimensional model-based measurement of tumors and lymph nodes is more convenient,intuitive and accurate than traditional imaging two-dimensional images,which can effectively assist the surgeon.Preoperative planning,formulate individualized surgical plan,and realize precise surgery.2.The three-dimensional reconstruction model has important guiding significance for thoraco-laparoscopic combined esophageal cancer radical surgery,reducing the operation time,intraoperative bleeding volume,24-hour postoperative drainage volume,increasing the number of lymph node dissection stations,patient compliance,and effectively assisting scientific research teaching. |
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