三维可视化系统在肝门部胆管癌外科手术中的应用  

Application of three-dimensional visualization system in surgical operation for hilar cholangiocarcinoma

作　　者：曾宁[1] 方驰华[1] 范应方[1] 杨剑[1] 项楠[1] 祝文[1] 刘军[1] 方兆山 陈青山[1] 

机构地区：[1]南方医科大学珠江医院肝胆一科,广州510282

出　　处：《中华肝脏外科手术学电子杂志》2015年第4期202-205,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家高技术研究发展计划(863计划)项目(2006AA022346;2012AA022305);国家自然科学基金(81170458);广东省重大科技专项(2012A080203013);广东省中科院全面战略协作项目(20100904);广东省科技计划项目(2011B031800088);广东省医学科研基金(A2011376)

摘　　要：目的探讨三维可视化系统（MI-3DVS软件系统）在肝门部胆管癌术前评估和手术规划中的应用价值。方法本前瞻性研究对象为2009年6月至2013年12月在南方医科大学珠江医院应用MI-3DVS软件进行术前评估的13例肝门部胆管癌患者。所有患者均签署知情同意书,符合医学伦理学规定。其中男8例,女5例;年龄34~81岁,中位年龄55岁。采用64排或256排螺旋CT进行肝、胆、胰、脾和腹腔血管等增强扫描,采集患者平扫期、动脉期、门静脉期和静脉期的4套医学数字成像和数据。将患者各期数据导入MI-3DVS,进行图像分割和三维重建。对重建图像进行可视化处理后,观察肿瘤与肝内胆管、肝动脉、门静脉系统和肝静脉系统的三维立体关系,并进行Bismuth-Corlette分型,模拟手术并制定手术方案。结果 13例患者的重建模型均准确显示肝脏形态及其管道系统的解剖标志,肝门部胆管癌、肝内各种管道系统等结构形态逼真,立体感强,各分支走向清晰。根据三维重建结果对肿瘤进行Bismuth-Corlette分型,Ⅲa型1例,Ⅲb型7例,Ⅳ型5例。术前三维重建对肿瘤分型诊断准确率100%（13/13）。模拟手术与实际手术方式符合率为85%（11/13）。患者的手术时间为630（300~720）min,术中出血量420（110~1 800）ml;手术并发症发生率23%（3/13）,其中切口感染2例,胆漏1例,均经保守治疗痊愈。结论三维可视化系统能准确、直观、动态地显示肝门部胆管癌及其三维毗邻关系,可对患者进行准确的术前评估和手术规划。Objective To investigate the application value of three-dimensional visualization system （MI-3DVS software system） in the preoperative evaluation and surgical planning for hilar cholangiocarcinoma. Methods Thirteen patients with hilar cholangiocarcinoma undergoing preoperative evaluation with MI-3DVS software in Zhujiang Hospital, Southern Medical University between June 2009 and December 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 13 patients, 8 were males and 5 were females with the age ranging from 34 to 81 years old and the median of 55 years old. Enhanced scan of liver, gallbladder, pancreas, spleen and blood vessels in abdominal cavity was performed on the patients with 64-slice or 256-slice spiral CT. Four sets of medical digital imaging and data of plain scan phase, arterial phase, portal venous phase and venous phase were collected. The data of each phase were introduced into MI-3DVS to perform image segmentation and three-dimensional reconstruction. The three-dimensional relationship between tumor and intrahepatic bile duct, hepatic artery, portal venous system and hepatic venous system was observed after the reconstructed images were visualized and Bismuth-Corlette classification was determined for the tumors. Moreover, surgery was simulated and surgical planning was formulated. Results The reconstructed models of 13 patients all exactly displayed the shape of liver and anatomic landmark of duct system. The structure and shape of hilar cholangiocarcinoma and various intrahepatic duct systems were realistic and stereoscopic and the direction of various branches was clear. Bismuth-Corlette classification of tumors was determined according to the results of three-dimensional reconstruction. One case was type Ilia, 7 were type Ⅲb and 5 were type Ⅳ. The accuracy rate of tumor classification was 100%（13/13） by preoperative three-dimensional reconstruction. The coincidence ra

关 键 词：成像 三维 三维可视化系统 胆管肿瘤 肝门部胆管癌 外科手术 

分 类 号：R735.8[医药卫生—肿瘤]