腹腔镜手术的虚拟仿真研究  

Virtual simulation research on laparoscopic surgery

作　　者：方驰华[1] 吴东波[1] 鲍苏苏[2] 潘家辉[2] 鲁朝敏[1] 黄燕鹏[1] 

机构地区：[1]南方医科大学珠江医院肝胆外科,广东广州510282 [2]华南师范大学计算机学院,广东广州510631

出　　处：《中国内镜杂志》2009年第4期337-340,共4页China Journal of Endoscopy

基　　金：国家自然科学基金(30470493);广东省自然科学基金团队项目(6200171);国家863计划资助项目(编号2006AA02Z346)

摘　　要：目的研究虚拟仿真技术在腹腔镜技术的培训和临床手术中的意义。方法采集1例胆管结石患者的64排螺旋CT扫描数据,通过自适应区域生长算法对CT序列图像进行图像程序分割和自动提取,然后运用医学图像处理系统MIPS(medical images process system)软件进行三维重建。将重建后的STL图像文件导入到FreeForm Modeling System进行平滑和修整,建立腹腔镜虚拟手术操作系统,并以腹腔镜左半肝叶切除为例,利用力反馈设备PHANToM,进行腹腔镜手术的虚拟仿真研究。结果建立的腹腔镜手术操作模型具有腹壁和肝、胆、胰、脾以及它们的比邻血管等腹部器官,形态逼真、立体。在腹腔镜虚拟手术系统中,操作者可以随意操纵腹腔镜器械,模拟钳夹、拨动、切割与缝合等动作。利用建立的手术虚拟环境,通过操纵腹腔镜器械,能够模拟腹腔镜手术的操作过程,包括气腹针和套管针的穿刺,腹腔镜、结扎速和吸引器的插入等。腹腔镜左半肝叶切除得到准确的模拟,有很强的真实感和临场感。结论腹腔镜仿真手术操作系统可以缩短腔镜医师手术培训的时间、减少培训的成本和缩短腹腔镜手术的学习曲线;术前进行虚拟手术演示可以提高腹腔镜的手术效果、降低手术风险及减少手术并发症。[Objective] To investigate the training and clinical significances of virtual laparoscopie surgery simulation. [Methods] One patient who suffered from biliary calculus was scanned by 64-slice-helieo-eomputerized tomography （CT） and the data were collected. Segmentation and automatic extraction of the images from CT were performed by auto-adaptation region growing algorithm, and three-dimensional reconstruction was carried out by software MIPS. The moulds were then imported to the FreeForm Modeling System with format STL for smoothing and trimming. At last, virtual laparoscopie surgery simulation system was constructed. As an example, laparoseopie left hepatic tobectomy was simulated with the force-feedback equipment （PHANTOM）. [Results] The reconstructed 3D laparoseopie surgery model had great verisimilar images of abdominal wall, liver, biliary duet, pancreas, spleen and blood vessels around them. In the virtual laparoseopic surgery simulation system, the laparoseopie instruments could be man{pulated freely for clamping, turning, cutting and suturing. The laparoscopie procedures could be simulated, such as Veress needle and troear puncture, inserting laparoscope, and interpolating LigaSure and suetor. The laparoseopic surgery could also be imitated really and lively for left hepatic lobectomy. [Conclusions] It can shorten the training time and. reduce the training cost and decrease the learning curve for learner to train in this virtual laparoseopic surgery system. It can improve the surgical effect and decrease the surgical risk and reduce the complications through demonstrating visualized operation before laparoscopie surgery.

关 键 词：腹腔镜手术 三维重建 虚拟系统 

分 类 号：R656[医药卫生—外科学]