探讨三维可视化技术联合术中超声在3D腹腔镜胰十二指肠切除术（3D-LPD）中的临床应用价值。

回顾性分析2020年7月至2021年3月在广州中医药大学第一附属医院行3D-LPD的13例患者临床资料。其中男8例，女5例；平均年龄（60±8）岁。术前影像学检查示肿瘤位于胰头部、胆总管下段或壶腹部。患者均签署知情同意书，符合医学伦理学规定。将术前CT或MRI影像资料导入三维可视化软件中进行三维重建，立体化显示肿瘤的位置，精准判断肿瘤与周围组织、脉管的关系，以及有无血管变异，制定具体的手术方案。术中超声定位行3D-LPD。

术前三维重建图像可清晰显示肿瘤与邻近组织器官的关系，判断血管变异，精准定位手术范围及规划手术方案；术中3D腹腔镜可获得良好的纵深感和立体感。术前三维重建与术中所见相符。13例患者均顺利完成手术，无中转开腹。手术时间（405±49）min，术中出血量（109±59）ml。术后B级胰瘘2例，经积极引流后治愈，无发生C级胰瘘；术后腹腔出血1例，介入治疗后治愈。术后病理报告均为R0切除，胰腺或壶腹部周围恶性肿瘤11例，良性肿瘤2例。13例患者均康复出院，无死亡病例。随访1~8个月，1例患者肿瘤复发，余患者无瘤存活。

三维可视化技术联合术中超声有助于术前明确肿瘤大小及其与周围组织、脉管的关系，解剖变异和术中精准定位，在3D-LPD中可精准、完整切除病灶，保证手术安全。

To evaluate the clinical application value of three-dimensional (3D) visualization combined with intraoperative ultrasound in D laparoscopic pancreaticoduodenectomy (3D-LPD).

Clinical data of 13 patients who underwent D-LPD in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from July 2020 to March 2021 were retrospectively analyzed. Among them, 8 patients were male and 5 female, aged (60±8) years on average. Preoperative imaging examination showed that the tumors were located in the head of pancreas, the lower part of common bile duct or ampulla. The informed consents of all patients were obtained and the local ethical committee approval was received. The preoperative CT or MRI imaging data were imported into D visualization software for D reconstruction. The location of the tumors was displayed in D patterns. The relationship between the tumors and surrounding tissues and vessels, was accurately determined, and vascular variation was found out, and surgical plan was determined. Intraoperative ultrasound-guided D-LPD was performed.

Preoperative D reconstruction images could explicitly display the relationship between tumors and adjacent tissues and organs, assess the vascular variation, accurately define the resection range and determine the surgical plan. Intraoperative D laparoscopy could achieve deep and stereoscopic sense. Preoperative D reconstruction was consistent with the intraoperative findings. 13 patients successfully completed the operation without conversion to open surgery. The operation time was (405±49) min. Intraoperative blood loss was (109±59) ml. 2 cases developed postoperative grade B pancreatic fistula, which was cured after active drainage. No grade C pancreatic fistula occurred. 1 patient suffered from postoperative abdominal hemorrhage, which was cured after interventional therapy. Postoperative pathological examination indicated all were R0 resection. 11 cases were diagnosed with malignant tumors surrounding the pancreas or ampulla, and 2 cases with benign tumors. All 13 patients were discharged after proper recovery. No death was observed. During 1-8 month follow-up, 1 patient recurred, and the remaining patients lived without tumor recurrence.

D visualization combined with intraoperative ultrasound contributes to preoperative evaluation of tumor size, its relationship with the surrounding tissues and vessels, anatomical variation and accurate intraoperative localization, which can accurately and completely resect the lesions and guarantee the safety in D-LPD.