三维可视化技术在精准肝胆管结石诊治中的应用  

Application of three-dimensional visualization technology in precise diagnosis and treatment for hepatolithiasis

作　　者：范应方[1] 方驰华[1] 陈建新[1] 项楠[1] 杨剑[1] 李克晓[1] 

机构地区：[1]南方医科大学珠江医院肝胆一科,广东广州510282

出　　处：《南方医科大学学报》2011年第6期949-954,共6页Journal of Southern Medical University

基　　金：国家高技术研究发展计划(863计划)(2006AA02Z346);广东省中科院产学研合作研究项目(20100904);广东省自然科学基金团队资助项目(6200171)~~

摘　　要：目的探索三维可视化技术在肝胆管结石病术前诊断、术前评估及手术指导方面的应用价值。方法对30例肝胆管结石病人的肝脏64排螺旋CT扫描原始数据,采用自主研发的腹部医学图像处理系统进行肝脏及胆道三维重建,根据三维重建结果进行术前诊断和病理分型,评估手术预案可行性及安全性,确定最佳手术方案后指导临床实际手术过程;并观察术中所见与仿真手术的符合程度以及患者结石残留情况。结果当肝脏设置为半透明时,可以清晰显示肝内、外胆管的立体解剖形态,病变胆管扩张及狭窄部位和程度,肝内结石的精确部位、大小及数量。术中所见与术前三维重建符合率、实际手术过程与术前仿真手术符合率均为100%,实际手术方案与术前预案符合率达到90%(27/30)。随访半年,复发率7.4%(2/27)。结论三维可视化技术可实现肝胆管结石病的术前精确诊断和术中精确操作,可有效降低术后复发率。Objective To assess the value of three-dimensional （3D） visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis. Methods The 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shaped tube. Results When the model setting was configured to render the liver translucent, the system clearly displayed the site and number of the bile duct calculi as well as the expansion or narrowing of the intrahepatic bile duct. A total consistency （100%） was found between the surgical findings and the preoperative findings based on the 3D model, and also between the actual surgical procedures and the preoperative simulation in 30 cases. The consistency rate between the actual surgical protocols and the preoperative surgical plan was 90%. Follow-up of 27 of the patients for 6 months showed a recurrence rate of 7.4% （2/27） after the operation. Conclusion The 3D visualization system allows accurate preoperative diagnosis and precise surgical operation to reduce the postoperative recurrence rate, and can be of value as a new diagnostic and treatment modality in biliary surgery

关 键 词：肝胆管结石 三维可视化 腹部医学图像处理系统 

分 类 号：R657.42[医药卫生—外科学]