Журнал включен
в систему цитирования Scopus

2017 г. №2 Том 25


DOI: https://dx.doi.org/10.18484/2305-0047.2017.2.177   |  


Preoperative 3D modeling splenectomy in patients with primary immune thrombocytopenia

FSBEE HE «Samara State Medical University», Samara
The Russian Federation

Objectives. To explore the possibilities of preoperative 3D modelling and analysis system based on multislice computed tomography data, to evaluate its effectiveness in performing laparoscopic splenectomy for the primary immune thrombocytopenia.
Methods. A female patient, (55 yrs) with the diagnosis of idiopathic thrombocytopenic purpura, recurrent course. For 10 years she had been observed and underwent the numerous courses of conservative treatment; she also took daily 60 mg of prednisolone. The blood platelet levels reduced below 30×109/l. The splenectomy was indicated due to the failure of conservative treatment. Multislice computed tomography with contrast bolus was performed. For preoperative planning a color 3D model of the surgical site was created on the basis of the obtained data in the “Autoplan” system. Systems giving the ability to plan surgical intervention combines the medical equipment, PACS system (picture archiving and communication system) available onsite advanced image-viewing workstations that can guide physicians; the ability to view images from various workstations via the network including the navigation enabling physicians to create the accurate and realistic models from stereo cameras, and to use computers as well as mobile computing devices directly in the operating room. The patient was underwent laparoscopic hybrid splenectomy.
Results. According to the 3D model a main type of vascularization of the spleen was revealed. The distal part of the pancreatic tail did not reach (1.5 cm) the gate of the spleen. Accessory spleens and periprotsess were absent. The data of 3D model were confirmed intraoperatively and allowed performing a laparoscopic hybrid splenectomy without technical difficulties precisely with a minimal blood loss. The postoperative period was uneventful. The patient was discharged on the 5th day in a satisfactory condition. The parameters of platelet level have reached the reference values (356×109/l).
Conclusion. Preoperative 3D modelling permits the surgeon to make pre-operative planning and provides him with important information on individual topographic and anatomic features in forthcoming operation sites. The information about the individual characteristics of the splenic vascularization and pancreatic topography in its gate lets to allocate and ligate vessels precisely, that improves the quality of hemostasis and also reduces the probability of the pancreatic injury. Preoperative visualization of accessory spleens increases the radicalism of the surgery.

Ключевые слова: splenectomy, thrombocytopenia, computer tomography, 3D modelling, hemostasis, vascularization
с. 177-182 оригинального издания
Список литературы
  1. Меликян АЛ, Пустовая ЕН, Цветаева НВ, Савченко ВГ. Клинические рекомендации по диагностике и лечению идиопатической тромбоцитопенической пурпуры (первичной иммунной тромбоцитопении) у взрослых. Москва, РФ; 2014. 42 с.
  2. Воробей АВ, Лурье ВН, Александров СВ, Римжа ЕА, Рылюк АФ, Швед ИА, и др. Место лапароскопической спленэктомии в хирургической гематологии. Новости Хирургии. 2007;15(2):52-64.
  3. Корытцев ВК, Быстров СА, Сухоруков ВВ, Толкачев ЮС. Гибридная операция при идиопатической тромбоцитопенической пурпуре. Хирургия Журнал им НИ Пирогова. 2015;(9):83-85.
  4. Гржимоловский А.В., Карагюлян С.Р., Данишян К.И. Лапароскопическая спленэктомия в гематологии. Эндоскоп Хирургия. 2003;9(4):3-14.
  5. Blackmore CC, Mecklenburg RS, Kaplan GS. Effectiveness of clinical decision support in controlling inappropriate imaging. J Am Coll Radiol. 2011 Jan;8(1):19-25. doi: 10.1016/j.jacr.2010.07.009.
  6. Brouwer OR, Buckle T, Bunschoten A, Kuil J, Vahrmeijer AL, Wendler T, et al. Image navigation as a means to expand the boundaries of fluorescence-guided surgery. Phys Med Biol. 2012 May 21;57(10):3123-36. doi: 10.1088/0031-9155/57/10/3123.
  7. Kwon YW, Powell KA, Yum JK, Brems JJ, Iannotti JP. Use of three-dimensional computed tomography for the analysis of the glenoid anatomy. J Shoulder Elbow Surg. 2005 Jan-Feb;14(1):85-90.
  8. Banz VM, Baechtold M, Weber S, Peterhans M, Inderbitzin D, Candinas D. Computer planned, image-guided combined resection and ablation for bilobar colorectal liver metastases. World J Gastroenterol. 2014 Oct 28;20(40):14992-96. doi: 10.3748/wjg.v20.i40.14992.
  9. Volonté F, Pugin F, Bucher P, Sugimoto M, Ratib O, Morel P. Augmented reality and image overlay navigation with OsiriX in laparoscopic and robotic surgery: not only a matter of fashion. J Hepatobiliary Pancreat Sci. 2011 Jul;18(4):506-9. doi: 10.1007/s00534-011-0385-6.
  10. Колсанов АВ, Зельтер ПМ, Манукян АА, Чаплыгин СС., Колесник ИВ. Применение системы по предоперационному моделированию на основе данных компьютерной томографии у больного эхинококкозом печени. REJR. 2016;6(2):111-14. doi: 10.21569/2222-7415-2016-6-2-111-114.
  11. Федоров ВД, Кармазановский ГГ, Гузеева ЕБ, Цвиркун ВВ. Виртуальное хирургическое моделирование на основе данных компьютерной томографии. Москва, РФ: Видар-М; 2003. 184 с.
Адрес для корреспонденции:
443079, Russian Federation,
Samara, Karl Marx pr., 165, «b»,
Clinics of Samara State Medical University,
department and clinic of hospital surgery.
Tel.: 8 10 846 276-77-89
е-mail: katorkinse@mail.ru
Sergey E.Katorkin
Cведения об авторах:
Katorkin S.E. PhD, Ass. Professor, Head of department and clinic of hospital surgery, FSBEE HE «Samara State Medical University».
Kolsanov A.V. MD, Professor, Head of operative surgery and clinical anatomy department with the course of innovative technologies, FSBEE HE «Samara State Medical University», Director of Institute of innovative Development, Head of the Center of breakthrough researches «Information Technologies in Medicine.»
Bystrov S.A., PhD, Ass. Professor, Head of clinic of hospital surgery, FSBEE HE «Samara State Medical University».
Chaplygin S.S. PhD, Ass. Professor of operative surgery and clinical anatomy department with the course of innovative technologies, FSBEE HE «Samara State Medical University».
Zelter P.M. PhD, Assistant of department radiology fnd radiotherapy with the course of medical information, FSBEE HE «Samara State Medical University».
Nazarov P.M. Surgeon of surgical department of the hospital surgery clinic, FSBEE HE «Samara State Medical University».
Контакты | ©Витебский государственный медицинский университет, 2007