中国实用外科杂志

中国实用外科杂志

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应用增强现实与混合现实导航预防腹腔镜肝切除术中出血价值研究

祝    文1，曾小军1，胡浩宇1，项    楠1，曾    宁1，贾富仓2，杨    剑1，方驰华1   

  1. 1南方医科大学珠江医院肝胆一科 南方医科大学珠江医院数字智能化研究所 广东省数字医学临床工程技术研究中心，广东广州 510282；2中国科学院深圳先进技术研究院，广东深圳 518055
  • 出版日期:2022-03-01

  • Online:2022-03-01

摘要： 目的    研究应用增强现实与混合现实导航技术预防腹腔镜肝切除术中出血的价值。方法    回顾性分析2018年1月至2021年7月南方医科大学珠江医院肝胆一科收治171例行腹腔镜肝切除术治疗肝脏恶性肿瘤病人临床资料，分为增强现实与混合现实腹腔镜肝切除手术导航组（A组）和常规腹腔镜肝切除组（B组）。其中A组108例，术中采用自主研发的3D腹腔镜增强现实与混合现实手术导航系统将术前三维模型、3D腹腔镜场景进行多模图像实时融合与交互，在导航技术引导下完成腹腔镜肝切除术。B组63例，未采用手术导航技术，采用常规腹腔镜肝切除。分别采用t 检验、Wilcoxon秩和检验、χ2检验对临床数据进行统计学分析。结果    两组病人的术前资料差异均无统计学意义。术中指标中，A组术中出血量少于B组［（263.9±147.0） mL vs.（405.6±286.5） mL，P＜0.01）］，差异有统计学意义；A组术中输血率低于B组（9.3% vs. 31.7%，P＜0.01），差异有统计学意义；两组病人均无严重并发症发生及围手术期死亡。结论    在腹腔镜肝切除中应用增强现实与混合现实导航技术出血更少，有更好的手术安全性，对术中预防出血具有重要的应用价值。

关键词: 混合现实, 增强现实, 腹腔镜肝切除术, 导航, 出血

Abstract: The research and practice of augmented reality and mixed reality navigation in the prevention of hemorrhage for 3D laparoscopic hepatectomy        ZHU Wen*，ZENG Xiao-jun，HU Hao-yu，et al. *First Department of Hepatobiliary Surgery，Zhujiang Hospital，Southern Medical University，Institute of Digital Intelligence，Zhujiang Hospital，Southern Medical University，Guangdong Provincial Clinical and Engineering Center of Digital Medicine，Guangzhou 510282，China
Corresponding authors：YANG Jiang,E-mail:yangjian486@126.com；FANG Chi-hua,E-mail:fangchihua@smu.edu.cn
Abstract    Objective    To investigate the application value of augmented reality and mixed reality navigation technology in preventing bleeding after three-dimensional laparoscopic hepatectomy.Methods    The clinical data of 171 patients treated with laparoscopic hepatectomy for liver malignancies in the First Department of Hepatobiliary Surgery，Zhujiang Hospital，Southern Medical University from January 2018 to July 2021 were analyzed.The patients were divided into two groups：augmented reality and mixed reality laparoscopic hepatectomy navigation group（group A）and routine laparoscopic hepatectomy group（group B）.Among them，108 patients in group A were performed laparoscopic hepatectomy using a 3D laparoscopic augmented reality surgical navigation system（software copyright No.2018SR840555），through which，the preoperative 3D reconstructed models were projected into the surgical field for real-time fusion and interaction of multi-model images，and 63 patients in group B were performed conventional 3D laparoscopic hepatectomy without surgical navigation technology.All the patients signed the informed consent，in line with medical ethics.Clinical data were statistically analyzed using t-test，Wilcoxon rank-sum test，and c2 test，respectively. Results    There was no significant difference in preoperative data between the two groups.Intraoperative blood loss in group A（263.9±147.0）mL vs. 405.6±286.5 mL，P＜0.01）and intraoperative blood transfusion rate（9.3% vs.31.7%，P＜0.01）were significantly lower than those in group B.There were no severe complications and perioperative death in the two groups. Conclusion    The use of augmented reality and mixed reality navigation technology in laparoscopic hepatectomy，which brings about more minor bleeding and better surgical safety，has a significant application value in the prevention of intraoperative bleeding.

Key words: mixed reality, augmented reality, laparoscopic hepatectomy, navigation, bleeding