医学图像三维可视化系统在肝胆管结石病诊断与治疗中的应用  

Application of medical image three dimensional visualization system in the diagnosis and treatment ofhepatolithiasis

作　　者：范应方[1] 方驰华[1] 游锦华[1] 钟世镇[1] 陈建新[1] 杨剑[1] 项楠[1] 

机构地区：[1]南方医科大学珠江医院肝胆外科,广州510282

出　　处：《中华消化外科杂志》2011年第4期271-273,共3页Chinese Journal of Digestive Surgery

基　　金：国家高技术研究发展计划（863计划）项目（2006AA022346）;广东省自然科学基金团队项目（6200171）;国家自然科学基金（30470493）;广东省中国科学院全面战略合作项目（2010A090100032）;广东省科技计划项目（20118031800088,20118031800091）

摘　　要：目的研究医学图像三维可视化系统（MI-3DVS）在肝胆管结石病诊断与治疗中的应用价值。方法收集2008年8月至2010年8月南方医科大学珠江医院收治的54例肝胆管结石病患者的肝脏64排螺旋CT扫描原始数据，采用MI-3DVS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，以及多种手术方案的术前仿真演练，确定最佳手术方案。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54例患者中，病理分型Ⅰ型11例，Ⅱ型5例（其中Ⅱa型2例、Ⅱb型3例），E型38例；肝内胆管狭窄23例；伴萎缩-肥大综合征27例。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，肝内胆管结石的部位、大小及数量可精确显示。仿真手术方案与实际手术的符合率为94％（51／54），51例择期手术患者术后无结石残留，全组术后结石残留率为6％（3／54）。结论MI-3DVS可实现肝胆管结石病的术前精确诊断和术中精细操作，可有效降低术后结石残留率。Objective To study the medical image three dimensional visualization system （M1-3DVS） in the diagnosis and treatment of hepatolithiasis. Methods The data of 64-slice spiral computed tomography of 54 patients with hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from August 2008 to August 2010 were collected. The liver and bile duct were three dimensionally （3D） constructed. Preoperative diagnosis and pathological classification were made according to the results of the 3D model of liver and bile duct. The optimal surgical procedure was determined by simulating operations based on the 3D model. The compliance of simulated operation and actual operation was observed, and residual stones were detected by cholangiography. Results Of the 54 patients, 11 were with type Ⅰ , 5 with type Ⅱ （ including 2 patients with type Ⅱ a and 3 with Ⅱ b）, 38 with type E. There were 23 patients with intrahepatic bile duct stricture and 27 with atrophy-hypertrophy syndrome complex. The anatomy of intra- and extrahepatic bile duct, dilation and stricture of the bile duet, site, size and number of the bile duct stones were clearly displayed in the MI-3DVS. The compli-ance rate of simulated surgery and actual surgery was 94% （51/54 ）. There was no residual stones in 51 patients who received elective surgery and the rate of residual stone of the 54 patients was 6% （3/54）. Conclusion Acurate preoperative diagnosis and intraoperative precise operation can be achieved and the rate of residual stone can be reduced by using the MI-3DVS.

关 键 词：胆石症 三维重建 医学图像三维可视化系统 

分 类 号：R657.4[医药卫生—外科学]