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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 15 ›› Issue (01) : 59 -65. doi: 10.3877/cma.j.issn.2095-3232.2026.01.010

临床研究

头戴式裸眼3D腔镜显示系统在腹腔镜肝切除术中的应用
阙园1,2,3, 赵增江1,2,3, 郑潇1,2,3, 黄从云3, 欧阳再兴3, 刘文瑛2,3,†()   
  1. 1　524000　广东省湛江市，广东医科大学第一临床医学院
    2　512025　广东省韶关市，广东医科大学粤北人民医院
    3　512025　广东省韶关市，汕头大学医学院附属粤北人民医院肝胆外科
  • 收稿日期:2025-06-07 出版日期:2025-02-10
  • 通信作者: 刘文瑛
  • 基金资助:
    广东省生物医学创新平台建设项目(2018B09); 广东省教育厅临床教学基地教学改革研究项目(2023204); 韶关市科技计划项目(210805174532225)

Application of head-mounted naked-eye 3D endoscopic display system in laparoscopic hepatectomy

Yuan Que1,2,3, Zengjiang Zhao1,2,3, Xiao Zheng1,2,3, Congyun Huang3, Zaixing Ouyang3, Wenying Liu2,3,†()   

  1. 1 First Clinical Medical School, Guangdong Medical University, Zhanjiang 524000, China
    2 Yuebei People's Hospital of Guangdong Medical University, Shaoguan 512025, China
    3 Department of Hepatobiliary Surgery, Yuebei People's Hospital of Shantou University Medical College, Shaoguan 512025, China
  • Received:2025-06-07 Published:2025-02-10
  • Corresponding author: Wenying Liu
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引用本文：

阙园, 赵增江, 郑潇, 黄从云, 欧阳再兴, 刘文瑛. 头戴式裸眼3D腔镜显示系统在腹腔镜肝切除术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 15(01): 59-65.

Yuan Que, Zengjiang Zhao, Xiao Zheng, Congyun Huang, Zaixing Ouyang, Wenying Liu. Application of head-mounted naked-eye 3D endoscopic display system in laparoscopic hepatectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 15(01): 59-65.

目的

探讨头戴式裸眼3D腔镜显示系统在腹腔镜肝切除术中的临床应用价值。

方法

回顾性分析2020年1月至2021年6月在粤北人民医院行腹腔镜肝切除术的71例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男40例，女31例；年龄33 ~70岁，中位年龄54岁。根据术中使用3D腹腔镜设备不同，将患者分为传统3D腹腔镜组（传统组31例）和头戴式裸眼3D腔镜显示系统组（实验组40例）。观察分析两组患者的围手术期资料及主刀、第一助手手术医师主观感受评分指标。

结果

所有患者均顺利完成手术，无中转开腹。实验组的手术时间（177±59） min，明显少于传统组的（207±60） min，差异有统计学意义（t=-2.098，P<0.05)。实验组主刀医师和第一助手手术医师沉浸感、肩颈疲劳、手眼协调性、眼睛疲劳主观感受评分分别为（4.0±0.4）和（4.2±0.3）分、（4.0±0.3）和（4.0±0.4）分、（4.1±0.4）和（4.1±0.4）分、（4.0±0.4）和（4.0±0.3）分，均高于传统组的（3.4±0.7）和（3.1±0.3）分、（3.5±0.4）和（3.7±0.3）分、（3.2±0.3）和（3.4±0.3）分、（3.5±0.4）和（3.7±0.3）分（t=4.189和15.609，7.335和13.812，10.544和8.912，5.399和4.492，P<0.05）；而两组图像清晰度、锐度、色彩重现、深度定位、深度分辨率、深度运动、眩晕感方面比较，差异无统计学意义（P>0.05)。

结论

头戴式裸眼3D腔镜显示系统能在腹腔镜肝切除术中提供术者沉浸式手术视觉体验，缓解视觉、颈部疲劳，提高手眼协调性，缩短手术时间，提高手术效率，安全性好。

关键词: 裸眼3D, 3D腹腔镜, 腹腔镜肝切除术, 沉浸感, 疲劳
Objective

To evaluate clinical application value of head-mounted naked-eye 3D endoscopic display system in laparoscopic hepatectomy.

Methods

Clinical data of 71 patients undergoing laparoscopic hepatectomy in Yuebei People's Hospital from January 2020 to June 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 40 patients were male and 31 female, aged from 33 to 70 years, with a median age of 54 years. According to intraoperative use of different 3D laparoscopic devices, all patients were divided into the traditional 3D laparoscopic group (traditional group, n=31) and head-mounted naked-eye 3D endoscopic display system group (study group, n=40). Perioperative data of patients and the subjective feeling score of the chief surgeon and the first assistant surgeon in two groups were observed and analyzed.

Results

All patients successfully completed laparoscopic hepatectomy, and there was no conversion to open surgery. The operation time in the study group was (177±59) min, significantly shorter than (207±60) min in the traditional group, and the difference was statistically significant (t=-2.098, P<0.05). In the study group, the subjective feeling scores of degree of immersion, shoulder and neck fatigue, hand-eye coordination and eye fatigue of the chief surgeon and the first assistant surgeon were (4.0±0.4) and (4.2±0.3), (4.0±0.3) and (4.0±0.4), (4.1±0.4) and (4.1±0.4), and (4.0±0.4) and (4.0±0.3), higher than (3.4±0.7) and (3.1±0.3), (3.5±0.4) and (3.7±0.3), (3.2±0.3) and (3.4±0.3), (3.5±0.4) and (3.7±0.3) in the traditional group (t=4.189 and 15.609, 7.335 and 13.812, 10.544 and 8.912, 5.399 and 4.492, all P<0.05). However, no significant differences were observed in image clarity, sharpness, color reproduction, depth positioning, depth resolution, depth movement and dizziness between two groups (all P>0.05).

Conclusions

Head-mounted naked-eye 3D endoscopic display system can provide surgeons with immersive visual experience, relieve visual and neck fatigue, improve hand-eye coordination, shorten operation time, enhance surgical efficiency and maintain surgical safety in laparoscopic hepatectomy.

Key words: Naked-eye 3D, 3D laparoscopy, Laparoscopic hepatectomy, Immersion, Fatigue
表1 两组肝切除患者一般临床资料比较
指标 实验组 传统组 统计值 P值
性别(例) χ2=0.067 0.796
男 22 18
女 18 13
年龄(岁,
±s)		 53±9 55±11 t=0.975 0.333
BMI(kg/m2,
±s)		 23±3.1 23.3±2.8 t=1.020 0.311
ALB(g/L,
±s)		 42±4 41±4 t=0.809 0.421
ALT[U/L, M(Q1, Q3)] 22(16, 30) 25(17, 37) Z=0.800 0.424
AST[U/L, M(Q1, Q3)] 24(18, 28) 20(18, 34) Z=0.423 0.672
原发病(例) χ2=0.009 0.996
原发性肝癌 23 18
肝良性肿瘤 12 9
继发性肝癌 5 4
慢性病史(例) χ2=0.561 0.953
肝炎 12 10
糖尿病 3 3
高血压 2 2
图1 头戴式裸眼3D腔镜显示系统术中使用情况 注：a为术者佩戴正面观；b为术者佩戴侧面观；c为头戴式裸眼3D显示系统左右眼单独显示画面（白色箭头）
表2 两组患者手术情况比较
指标 实验组 传统组 统计值 P值
手术方式(例) χ2=3.594 0.309
肝段切除术 14 8
联合肝段切除术 14 7
肝叶切除术 10 14
半肝切除术 2 2
手术时间(min,
±s)		 177±59 207±60 t=-2.098 0.040
入肝血流阻断时间(min,
±s)		 27.9±4.5 27.6±4.9 t=0.313 0.756
术中出血量[ml, M(Q1, Q3)] 110(100, 200) 150(120, 200) Z=1.836 0.066
表3 两组术后恢复情况比较
指标 实验组 传统组 统计值 P值
术后24 h腹腔引流量[ml, M(Q1, Q3)] 120(85, 150) 120(100, 180) Z=0.920 0.358
ALB(g/L,
±s)		 35±4 33±4 t=1.686 0.096
ALT[U/L, M(QR)] 135(94, 182) 140(102, 209) Z=0.412 0.681
AST[U/L, M(Q1, Q3)] 145(121, 178) 183(97, 230) Z=0.858 0.391
术后拔管时间[d, M(Q1, Q3)] 5(3, 6) 5(4, 7) Z=1.907 0.056
术后并发症(例) 2 4 χ2=0.573 0.449
术后住院时间[d, M(Q1, Q3)] 8(7, 9) 8(6, 10) Z=0.234 0.815
表4 两组主刀和第一助手主观感受评分比较
指标 主刀医师 第一助手
实验组 传统组 t值 P值 实验组 传统组 t值 P值
沉浸感 4.0±0.4 3.4±0.7 4.489 <0.001 4.2±0.3 3.1±0.3 15.609 <0.001
肩颈疲劳 4.0±0.3 3.4±0.4 7.335 <0.001 0.04±0.4 3.0±0.3 13.812 <0.001
图像清晰度 4.1±0.5 4.0±0.4 1.322 0.190 4.2±0.4 4.1±0.5 0.924 0.359
锐度 4.0±0.3 4.1±0.3 1.749 0.085 4.1±0.4 4.1±0.4 0.271 0.787
色彩重现 4.1±0.4 4.1±0.4 0.160 0.873 4.0±0.4 4.0±0.4 0.491 0.625
深度定位 4.1±0.4 4.1±0.4 0.380 0.705 4.0±0.4 4.0±0.4 0.397 0.692
深度分辨率 4.1±0.4 4.1±0.3 0.151 0.881 4.2±0.4 4.1±0.4 0.861 0.392
深度运动 4.1±0.3 4.0±0.3 0.603 0.548 4.2±0.4 4.0±0.3 1.880 0.064
手眼协调性 4.1±0.4 3.2±0.3 10.544 <0.001 4.1±0.4 3.4±0.3 8.912 <0.001
眩晕感 4.1±0.3 4.1±0.3 0.096 0.924 4.1±0.4 3.9±0.4 1.553 0.125
眼睛疲劳 4.0±0.4 3.5±0.4 5.339 <0.001 4.0±0.3 3.7±0.3 4.492 <0.001
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