摘要目的 探讨三维可视化技术在胰腺肿瘤术前评估中的应用价值.方法 回顾性分析2016年6月至9月南京军区南京总医院普通外科研究所肝胆胰腺病区收治的26例胰腺肿瘤患者的临床资料.男性18例,女性8例;年龄23 ～ 77岁,平均(57±12)岁.恶性肿瘤20例,良性肿瘤6例.应用三维可视化技术将患者术前二维CT图像进行三维可视化重建,观察胰腺肿瘤累及范围、肿瘤与血管关系、胰周肿大淋巴结情况等.结果 26例患者的CT图像三维可视化重建后,可清晰立体地显示肿瘤与肠系膜动静脉的关系(24例)及血管解剖变异(3例),清晰显示可疑的淋巴结(12例),发现小的肝脏转移(1例).15例评估后行胰腺肿瘤切除,三维重建肿瘤的解剖关系与术中大致相符.将三维重建用于胰腺癌新辅助化疗肿瘤大小及范围评估5例.结论 三维可视化技术能够对胰腺肿瘤术前进行精准评估,在明确解剖变异、肿瘤大小、肿大淋巴结等方面具有一定的临床应用价值.

abstractsObjective To study the value of three-dimensional(3D) visualization in the diagnosis and surgical treatment for pancreatic tumor.Methods From June to September 2016,26 patients with pancreatic tumors in Jinling Hospital,Medical School of Nanjing University were involved.The study included 26 patients(8 females and 18 males) with mean age of (57±12)years (ranging from 23 to 77 years).And there were 20 malignant tumors and 6 benign tumors.All of them were examined with abdominal thin slice CT scanning and the CT images were imported into 3D visualization system for 3D visualization.The main elements examined by 3D visualization included tumor shape,size,and location;distribution and morphology of the peripancreatic lymph node;the relationships among neoplasms,organs and blood vessels.Results Among the 26 patients,there were 21 cases with pancreatic cancer,of which 15 cases successfully underwent standard pancreatectomy.All patients were operated underwent accurate assessment.The 3D model demonstrated the origination and bifurcations of blood vessels,and the relationships among neoplasms,organs and blood vessels efficiently.The 3D technique could facilitate to evaluate response of neiadjuvant chemotherapy in the pancreatic cancer patients (n=5).3D reconstruction could detect the lymph-node metastases accurately (n =12) in patients with pancreatic cancer.3D reconstruction were applied to evaluate the the size and range of tumor on 5 cases.Conclusions 3D reconstruction allows stereoscopic identification of the spatial relationships between physiologic and pathologic structures.The 3D technique could facilitate to evaluate distribution and morphology of the peripancreatic lymph node,and to evaluate the relationships among neoplasms,organs and blood vessels.