陈家阳?莫志康?王宏伟?刘熙?吉成岗?陈杰桓

【摘要】目的 探討数字化技术在胰头癌手术中的应用价值。方法 收集10例胰头癌患者的临床资料。采用三维（3D）可视化技术观察血管的变异情况、胰头癌累及的范围、肿瘤与血管关系、胰周肿大淋巴结情况等，同时结合3D打印技术进行实时手术引导。分析术前规划结果、手术情况、手术前后肝功能及糖链抗原199（CA199）水平变化、术后并发症及近期疗效。结果 10例胰头癌患者均完成了基于数字化技术的术前规划及术中导航。所有患者均顺利完成手术。手术时间（315.1±59.5）min，术中出血量325（200，450）ml，手术切缘均达到R0切除标准。10例患者的术后总胆红素、直接胆红素、ALT、AST、CA199均比术前下降（P均< 0.05）。术后发生B级胰瘘1例，经保守治疗后痊愈，无围术期死亡病例。结论 数字化技术适用于胰头癌的术前规划和术中导航，有助于提高手术成功率，降低手术风险。

【关键词】数字化技术;胰头癌;外科手术;三维可视化;三维打印

Application of digital technology in the surgery for pancreatic head carcinoma Chen Jiayang， Mo Zhikang， Wang Hongwei， Liu Xi， Ji Chenggang， Chen Jiehuan. Department of General Surgery， Dongguan Binhai Bay Central Hospital， Dongguan 523900， China

Corresponding author， Chen Jiehuan， E-mail： chenjiehuan007@ 126. com

【Abstract】Objective To evaluate the application value of digital technology in the surgery for pancreatic head carcinoma. Methods Clinical data of 10 patients with pancreatic head carcinoma were collected. Three-dimesnional （3D） visualization technology was employed to observe the variation of blood vessels， the invasion area of pancreatic head carcinoma， the relationship between tumor and blood vessels and the enlarged lymph nodes around the pancreas， etc. Meanwhile， 3D printing was used to conduct real-time surgical guidance. Preoperative planning results， surgical condition， changes of liver function and CA199 level after operation， postoperative complications and short-term efficacy were analyzed. Results All 10 patients successfully completed preoperative planning and intraoperative navigation based on digital technology. Surgical treatment was performed successfully in all patients. The average operation time was （315.1±59.5） min， and the mean intraoperative blood loss was 325 （200， 450） ml. All of them reached the criteria of R0 resection. The levels of total bilirubin （TBIL）， direct bilirubin （DBIL）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST） and CA199 were significantly decreased after operation （all P < 0.05）. Postoperatively， 1 patient developed grade B pancreatic fistula and was recovered through conservative treatment. No perioperative death was reported. Conclusion Digital technology is applicable to preoperative planning and intraoperative navigation of pancreatic head carcinoma， which contributes to improving the success rate of surgery and lowering the risk of surgery.

【Key words】Digital technology;Pancreatic head carcinoma;Surgery;

Three-dimensional visualization;Three-dimensional printing

近年来，胰头癌的发病率在国内外均呈明显的上升趋势[1]。其恶性程度极高。手术切除是唯一的根治方法，常用的术式为胰十二指肠切除术。胰十二指肠切除术涉及的解剖结构复杂、手术难度大、术后并发症发生率高，被认为是普通外科最复杂的手术之一。精准化、个体化的手术策略有助患者达到更大的生存获益。目前基于薄层CT或MRI数据的三维（3D）可视化系统在国内外的应用日趋广泛，而3D打印是一种以3D可视化数字模型为基础，运用粉末状金属或塑料等可黏合材料，通过逐层打印的方式来构造物体的技术，其实现了3D平面图像向3D空间物理模型的跨越式转变[2-3]。3D打印已经逐渐应用于胰腺恶性肿瘤的诊断和治疗，并且发挥了重要的作用。……