在体盆腔淋巴结切除术数字化三维导航模型的构建和应用初步探讨  

Preliminary study of construction and application of in vivo digitalized three- dimensional navigational modelsfor pelvic lymphadenectomy

作　　者：段慧[1] 陈春林[1] 刘萍[1] 苏桂栋[1] 龚时鹏[1] 许乙凯[2] 陈兰[1] 李维丽[1] 陈瑞莹[2] 唐雷[3] 李鉴轶[3] 王张林 李朋飞[1] 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]南方医科大学南方医院影像中心,广东广州510515 [3]南方医科大学基础医学院解剖学教研室,广东广州510515

出　　处：《中国实用妇科与产科杂志》2015年第1期53-58,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81272585);广东省自然科学基金(S2011010003830)

摘　　要：目的构建在体盆腔淋巴结切除术数字化三维导航模型,并探讨其在临床应用中的意义。方法通过采集1例2014年11月就诊于南方医科大学南方医院妇科拟接受腹腔镜手术治疗的Ⅰb1期宫颈癌患者的CT血管成像DICOM数据集,应用数字化三维重建技术构建该患者的骨盆、盆腔血管、腰大肌、淋巴结及闭孔神经等解剖结构,组建盆腔淋巴结切除术数字化三维导航模型,并应用于腹腔镜下盆腔淋巴结切除术的实时导航。结果成功地构建了在体盆腔淋巴结切除术数字化三维导航模型,并完成了术中实时导航。在导航模型的导引下,顺利完成盆腔淋巴结切除,同时避免了对变异闭孔静脉的损伤。术中通过比较发现所构建模型包括盆腔血管的走行及与周围组织如骨盆、腰大肌、淋巴结的关系和患者实际的盆腔解剖结构一致。重建双侧淋巴结24个,实际切除淋巴结31个。结论在体盆腔淋巴结切除术数字化三维导航模型可辅助术者在术前熟悉患者实体解剖结构及变异情况,实时指导手术实施,避免血管等重要组织的损伤,提高手术安全性和成功率。Objective Construct in vivo digitalized three dimensional navigational models for use in pelvic lymphadenectomy and make a preliminary study of its significance in clinical application. Methods Through the use of the CT angiography DICOM data collection of a patient who was diagnosed at the Department of Gynecology at Southern Medical University＇s Nanfang Hospital in November 2014 and was scheduled to receive laparoscopic treatment for stage I bl cervical cancer, we used digitalized three-dimension reconstruction technology to reconstruct this patients pelvis, pelvic vasculature, psoas major muscle, lymph nodes, obturator nerve and other anatomical structures in order to create a pelvic lymphadenectomy digitalized three-dimensional navigational model. We then used this model as a real-time navigational guide in this patients pelvic lymphadenectomy operation. Results In this study an in vivo pelvic lymphadenectomy digitalized three-dimensional navigational model was successfully created and intra-operative real-time navigational assistance was completed.The abnormal obturator vein belongs to leftillia vein was susessfully avoiding damage during the procedure due to the three dimensional models.During the procedure, through comparison, it was discovered that the reconstructed model and the actual pelvic anatomy of the patient, including the anatomical relationship between the path of pelvic vessels and the surrounding structures such as the pelvis, psoas major and lymph nodes, were identical.The number of lymph nodes 31 excised was slightly more than the number of lymph nodes 24 reconstructed. Conclusions In vivo pelvic lymhpadenectomy digitalized three-dimensional models can successfully assist surgeons to grasp the individual in vivo anatomical characteristics of patients. It offers real-time surgical navigational assistance, preventing injury to important tissues such as blood vessels and increasing operational safety and success rates.

关 键 词：在体 盆腔淋巴结切除术 数字化 三维 导航 模型 

分 类 号：R711[医药卫生—妇产科学]