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近期，臨床外科人工智能醫療企業精診科技與中國人民解放軍總醫院第一醫學中心張旭教授（中華醫學會泌尿外科分會候任主委）、馬鑫教授、杜松良醫生合作在國際泌尿學頂級SCI雜志《UROLOGY》上發表臨床研究成果。
論文系統闡述了精診科技“TrueSight?”人工智能技術，在此類病變手術治療創新性應用。通過三維重建，精準展示腎靜脈及下腔靜脈側支循環結構，為醫生術中精準阻斷血管提供更為可靠的參考依據。
論文題目
精診科技醫工結合，發揮獨特的技術優勢，顯著提高了手術決策的成功率，進一步完善了腎癌伴下腔靜脈癌栓的微創治療體系，為醫生提供強有力的技術支持。
對于腎細胞癌合并下腔靜脈癌栓的患者來說，根治性切除腎癌的同時切除下腔靜脈癌栓可以獲得良好的預后，但是由于術中分離腫瘤時擠壓下腔靜脈可能導致癌栓脫落引起肺栓塞，手術風險極大。
醫生需要通過下腔靜脈造影和計算機斷層掃描（CT）來綜合評估側支循環的情況，判斷是否需要下腔靜脈重建。
中國人民解放軍總醫院第一醫學中心腎臟疾病重點實驗室、放射科、介入放射科醫生，選取2017-2018年之間7例左腎細胞癌伴下腔靜脈癌栓患者，術前使用精診科技“TrueSight?”人工智能技術對CT影像進行了三維重建。
同下腔靜脈造影相比，精診科技的人工智能血管追蹤技術可以更為精細地展示腎靜脈及下腔靜脈側支循環，幫助醫生評估側支循環是否充足，并通過模擬切除右腎靜脈上方和第二肝門下方的下腔靜脈部分，觀察切除術后可能的右腎靜脈引流途徑。
清華智能疫情防控體系
第一排右二為精診臨床AI輔助分析系統
精診“TrueSight?”AI三維重建結果與術中所見吻合
7名患者均接受了左腎細胞癌切除及下腔靜脈部分切除術，無需下腔靜脈重建，術后恢復良好。該研究表明，精細化的血管追蹤重建技術在此類手術中等同下腔靜脈造影具有顯著效果。
“張旭教授認為，任何一場勝仗，都離不開團隊的通力合作，強有力的醫療技術支持和組織協調保障顯著提高了手術決策的成功率?！?
bstract
OBJECTIVE
To present our preliminary experience of robotic left radical nephrectomy (LRN) and segmental inferior vena cava (IVC) resection without caval replacement for left renal cell carcinoma (RCC) with inferior vena cava tumor thrombus.
MATERIALS AND METHODS
Between 2017 and 2018, 7 patients underwent segmental IVC resection and LRN robotically. All patients underwent preoperative cavography, demonstrating complete IVC occlusion. Computed tomography-based 3-dimensional reconstruction revealed sufficient collateralization of the IVC and right renal vein (RRV). The cephalic IVC was circumferentially resected and ligated just below the second porta hepatis. The caudal IVC was circumferentially resected above the RRV with preservation of the major collaterals. The RRV was not dissected during the procedure to avoid compromising its neocollaterals. The IVC portion between the RRV and the second porta hepatis was removed en bloc with the tumor thrombus, and the LRN was performed.
RESULTS
All cases were successfully performed by robotic surgery without conversion. Median operative time was 420 minutes. Median intensive care unit stay was 3 days. Four grade Ⅱ complications occurred in 2 patients. One patient had mild LEE postoperatively and recovered without special medication. Median preoperative and 3-6 months follow-up serum creatinine was 118.7 mmol/L and 135.2 mmol/L, respectively. No patient needed dialysis postoperatively. One case occurred disease progression. No patient died during the follow-up period.
CONCLUSION
Robotic segmental IVC resection for left RCC with inferior vena cava tumor thrombus is feasible in well-selected cases. Three-dimensional reconstruction and cavography are helpful in the preoperative evaluation of neocollaterals in patients with suprarenal IVC occlusion.
