Preoperative simulation of partial nephrectomy with three-dimensional computed tomography
Preoperative simulation of partial nephrectomy with three-dimensional computed tomography
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DOI：
10.1046/j.1464-410x.2000.00898.x
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发表时间：
2000-11-01
影响因子：
4.5
通讯作者：
Schubert, J
中科院分区：
文献类型：
--
作者：
Wunderlich, H;Reichelt, O;Schubert, J
目的前瞻性评价计算机辅助三维（3D）体积渲染计算机断层扫描（CT）在确定合适的解剖范围（肿瘤大小、肿瘤位置、多灶性和血管供应）方面的准确性，并作为小体积肾癌（RCC）患者保留肾单元手术（NSS）术前模拟的潜在工具。患者和方法本研究包括36例经腹膜根治性肾细胞癌（RCC）直径< 4cm的患者。术前行螺旋CT，用三维体渲染CT显示肿瘤范围、肾大动静脉走行及肿瘤与肾集系统的关系。将CT结果与所有肾脏标本的病理结果进行比较，采用3-mm阶梯切片。结果36例患者在行肾切除术前发现肾肿瘤39例；未检出3个< 4 mm的肾脏病变。所有主静脉分支和43条动脉中的42条均通过三维体积渲染CT识别。了解这些特征后，模拟部分肾切除术；盆骨或血管系统的手术损伤将由模拟手术产生，在模拟切片表面上以颜色显示。结论计算机模拟提供了所有肾脏的三维重建，包括肿瘤、血管和肾门，可以更好地在术前评估肾脏肿块。可视化可能的切除边缘和预测手术风险似乎是这种新方法的主要优点，特别是在准备复杂手术时。重建的三维CT似乎是一个有用的工具来定义NSS的适应症和局限性。
Objective To evaluate prospectively the accuracy of computer-aided three-dimensional (3D) volume-rendered computed tomography (CT) in determining the appropriate anatomical limits (tumour size, tumour location, multifocality and vascular supply) and as a potential tool in the preoperative simulation of nephron-sparing surgery (NSS) in patients with small-volume renal cell carcinoma (RCC).Patients and methods The study included 36 patients who underwent transperitoneal radical nephrectomy for RCC of < 4 cm diameter. Helical CT was undertaken before surgery and the extent of the tumour, the course of major renal arteries and veins, and the relationship of the tumour to the collecting system were shown by 3D volume-rendered CT. The CT findings were compared with the pathological results of all kidney specimens, obtained using 3-mm step-sections.Results Before nephrectomy, 39 renal tumours were identified in the 36 patients; three renal lesions of < 4 mm were not detected. All main venous branches and 42 of 43 arteries were identified by 3D volume-rendered CT. Knowing these features, a partial nephrectomy was simulated; a surgical lesion to the pelvicalyceal or vascular system which would have been produced by the simulated surgery was displayed in colour on the simulated surface of the section.Conclusion Computer simulation provided an excellent 3D reconstruction of all kidneys, including the tumour, vasculature and renal hilum, allowing a significantly better preoperative evaluation of the renal mass. Visualizing possible resection margins and predicting the operative risks seem to be major advantages of this new method, especially when preparing for complex surgery. Reconstructed 3D CT appears to be a useful tool for defining the indications for and limitations of NSS.