摘要目的:探讨三维可视化技术在局部晚期分化型甲状腺癌精准诊治中的可行性和有效性。方法:回顾性分析2021年12月—2023年8月在中国人民解放军联勤保障部队第九六〇医院治疗的196例局部晚期分化型甲状腺癌患者临床资料，其中男性71例，女性125例，年龄18～77岁，平均43.7岁。所有患者均行颈部增强CT，根据术前是否对CT数据进行三维可视化处理将患者分为研究组(行三维可视化处理， n＝102)和对照组(未行三维可视化处理， n＝94)，运用SPSS27.0软件对两组患者基线资料进行1∶1倾向性评分匹配，卡钳值为0.02，两组分别得到49例患者，每组各包括首次手术患者35例，再次手术患者14例。70例首次手术患者中包括机器人手术29例，开放手术41例；28例再次手术患者中包括机器人手术4例，开放手术24例。研究组患者联合三维可视化模型对肿瘤及转移灶大小、空间位置、与周围器官毗邻关系进行全面评估，在可视化模型导航下行手术治疗；对照组仅在二维影像学图像的指导下完成手术。采用SPSS27.0统计学软件进行统计分析。 结果:所有患者手术均顺利完成。研究组与对照组患者基线资料差异无统计学意义( P>0.05)。首次手术患者中，研究组患者手术时间[175(145，200) min比205(182，249) min， P<0.001]、术后乳糜漏发病率(0比8.57%， P＝0.027)低于对照组，机器人手术占比(48.57%比34.28%， P＝0.225)、淋巴结清扫数目[46(40，62)枚比37(28，56)枚， P＝0.032]、颈淋巴结转移数目[15(7，22)枚比5(1，14)枚， P＝0.004]与转移淋巴结直径[12(10，16) mm比4(1，10)mm， P<0.001]高于对照组，两组患者的术中出血量、术后引流管放置天数、甲状旁腺功能减退发病率差异无统计学意义( P>0.05)。再次手术患者中，研究组手术时间[103.50(95.00，122.50)min比146.50(133.25，172.25) min， P<0.001]、术中出血量[12.50(8.75，22.50) mL比30.00(17.50，35.00) mL， P＝0.021]、术后带管天数[5.00(4.00，6.00) d比6.00(5.00，7.25) d， P＝0.016]及甲状旁腺功能减退发病率(7.14%比42.86%， P＝0.038)均少于对照组，机器人手术比率高于对照组(21.42%比7.14%， P＝0.596)。两组患者淋巴结清扫数目、淋巴结转移数目、乳糜漏发病率差异无统计学意义( P>0.05)。所有患者术后均无急性出血、切口感染并发症发生。 结论:三维可视化技术是局部晚期分化型甲状腺癌术前评估肿瘤及转移灶手术可切除的有效方法，可提高局部晚期分化型甲状腺癌手术的精准性、安全性。

abstractsObjective:To investigate the feasibility and effectiveness of three-dimensional visualization technology in the precise diagnosis and treatment of locally advanced differentiated thyroid cancer(DTC).Methods:A retrospective analysis was conducted on the clinical data of 196 patients with locally advanced DTC treated at the 960th Hospital of the PLA from December 2021 to August 2023. The cohort included 71 male and 125 female patients, with a mean age of 43.7 years (rangd from 18 to 77 years). All patients underwent neck-enhanced CT scans and were divided into two groups: the study group( n=102), which underwent preoperative three-dimensional visualization of CT data, and the control group( n=94), which did not. Baseline data for both groups were matched using SPSS27.0 with 1∶1 propensity score matching (PSM) and the caliper value was 0.02. A total of 49 patients were included in each group, including 35 first-time surgeries and 14 reoperation. Among the 70 first-time surgeries, 29 patients underwent robotic surgery and 41 underwent open surgery. Among the 28 reoperations, 4 underwent robotic surgery and 24 underwent open surgery. In the study group, three-dimensional visual models were used to comprehensively evaluate the tumor and metastatic lesion size, spatial location, and adjacent relationship with surrounding organs, surgical treatments were guided by these models, whereas the control group relied on two-dimensional imaging for guidance. The clinical data were statistically analyzed using SPSS27.0. Results:All operations were successfully completed. There were no statistical differences in baseline data between the two groups( P>0.05). Among first-time surgeries, the study group showed shorter operation times [175(145, 200) min vs 205(182, 249) min, P<0.001], a lower incidence of postoperative chyle leak (0 vs 8.57%, P=0.027), a higher rate of robotic surgery (48.57% vs 34.28%, P=0.225), a greater number of harvested lymph nodes [46(40, 62) vs 37(28, 56), P=0.032], a greater number of cervical lymph node metastasis[15(7, 22) vs 5(1, 14), P=0.004] and a larger diameter of metastasis lymph nodes[12(10, 16) mm vs 4(1, 10) mm, P<0.001]. There were no significant differences in intraoperative blood loss, postoperative drainage days and incidence of hypoparathyroidism( P>0.05). During the reoperation, the study group had shorter operation times[103.5(95.0, 122.5) min vs 146.50(133.25, 172.25) min, P<0.001], less intraoperative blood loss[12.50(8.75, 22.50) mL vs 30.00(17.50, 35.00) mL, P=0.021], fewer postoperative drainage days[5.00(4.00, 6.00) d vs 6.00(5.00, 7.25) d, P=0.016] and a lower incidence of hypoparathyroidism(7.14% vs 42.86%, P=0.038).The robotic surgery rate was higher in the study group (21.42% vs 7.14%, P=0.596). There were no significant differences in lymph node dissection numbers, metastatic lymph node counts, or chyle leak incidences between the two groups ( P>0.05). No acute bleeding or incision infection occurred in any patient postoperatively. Conclusion:Three-dimensional visualization technology is an effective preoperative assessment method for evaluating the resectability of tumors and metastases lesions in locally advanced DTC. It enhances the accuracy and safety of surgery for locally advanced DTC.