探讨三维可视化技术联合3D腹腔镜在超巨脾切除术中的应用价值。

回顾性分析2019年10月南方医科大学珠江医院行3D腹腔镜超巨脾切除术的1例脾功能亢进症患者临床资料。患者女，43岁，因"腹胀3 d"入院。患者已签署知情同意书，符合医学伦理学规定。患者脾明显肿大，脾下缘越过脐水平线3 cm，脾右缘越过前正中线2 cm。肝功能Child-Pugh分级A级，凝血功能无明显异常。上腹部增强CT及MRI提示肝硬化，门静脉高压症，巨大脾脏。术前将患者薄层CT数据导入三维可视化系统软件，构建个体化腹腔脏器3D模型，立体观察各脏器位置关系、脾脏体表投影、脾动脉走行等情况，在3D术前规划指导下进行3D腹腔镜超巨脾切除术。

重建的个体化3D模型可清晰、立体显示脾动脉和脾静脉走行、脾蒂形态及胰腺尾部与脾脏关系，测量脾脏最长径为252.5 mm，体积为1 561 ml。术中探查情况与术前规划一致，顺利完成手术。手术时间150 min，术中出血量50 ml。术后未发生腹腔出血、胰瘘、切口感染等并发症。

三维可视化技术可辅助制定精确的术前规划，结合3D腹腔镜行超巨脾切除术安全、可行。

To investigate the application value of 3D visualization combined with 3D laparoscopy in supergiant splenectomy.

Clinical data of 1 patient with hypersplenism who underwent 3D laparoscopic supergiant splenectomy in Zhujiang Hospital of Southern Medical University in October 2019 were retrospectively analyzed. The 43-year-old female patient was admitted to hospital due to abdominal distension for 3 d. The informed consent of the patient was obtained and the local ethical committee approval was received. The spleen of the patient was significantly enlarged, the lower edge of spleen exceeded3 cm of the umbilical horizontal line and the right edge exceeded 2 cm of the anterior midline. The liver function was classified as Child-Pugh grade A. No obvious abnormality was noted in coagulation function. Enhanced CT and MRI results of the upper abdomen indicated liver cirrhosis, portal hypertension and massive splenomegaly. Before operation, thin-layer CT scan data were imported into 3D visualization system software, and a 3D model of individualized abdominal organs was constructed. The anatomical relationship of organs, the projection of spleen surface, the course of splenic artery were observed in a three-dimensional pattern. Laparoscopic splenectomy was performed under the guidance of 3D preoperative planning.

The reconstructed individualized 3D model could explicitly and stereoscopically display the course of splenic artery and vein, the morphology of splenic pedicle and the anatomical relationship between pancreatic tail and spleen. The maximal diameter of spleen was measured as 252.5 mm and the volume was 1 561 ml. Intraoperative finding was consistent with the preoperative planning. The operation was successfully completed. The operation time was 150 min, and intraoperative blood loss was 50 ml. No postoperative complications, such as abdominal hemorrhage, pancreatic fistula and incisional infection, occurred.

3D visualization helps to make the accurate preoperative planning. 3D laparoscopic splenectomy is safe and feasible when combining with 3D visualization.