建立虚拟支架模型行术前模拟在TIPS治疗中的价值  

The value of establishment of virtual stent model for preoperative simulation in TIPS treatment

作　　者：魏欣[1] 胡鸿[1] 游箭[1] 钟立明[1] 廖运国 邓兴 蒲嘉骐 邓丹[1] WEI Xin;HU Hong;YOU Jian;ZHONG Liming;LIAO Yunguo;DENG Xing;PU Jiaqi;DENG Dan(Department of Interventional Radiology, Nanchong Central Hospital, the Second Clinical Institute of North Sichuan Medical College ,Nanchong 637000,Chin)

机构地区：[1]川北医学院第二临床学院南充市中心医院介入放射科,四川南充637000

出　　处：《实用放射学杂志》2018年第4期586-588,595,共4页Journal of Practical Radiology

摘　　要：目的 建立经颈静脉肝内门体分流术（TIPS）治疗所需介入器械和患者个体化术区结构的虚拟三维模型，探讨采用虚拟模型进行术前模拟在TIPS治疗中的价值。方法 在Mimics软件中重建8例患者上腹部CT扫描区域的骨骼、肝脏、门静脉、下腔静脉及肝静脉的三维结构，在3D MAX软件中建立虚拟RUPS-100穿刺套件及VIATORR支架模型，在计算机上进行RUPS-100穿刺套件经肝静脉穿刺门静脉路径和VIATORR支架释放位置的模拟评估。结果 ①建立的患者个体化三维模型有利于医生形成对肝静脉、门静脉空间关系的认识；②通过模拟获得了多角度、多部位的穿刺参数，有利于医生术中根据穿刺点调整穿刺方向；③通过模拟获得了VIATORR支架裸段在门静脉的位置，有利于评价所需支架的长度；④术前模拟均得出每例患者穿刺门静脉左支、右支、分叉部的参数，实际手术中穿刺门静脉分叉部4例、右支2例、左支2例；⑤术前模拟均采用8 mm×6 cm×2 cm规格的VIATORR支架，实际手术中第1例缺乏经验，支架裸段位置较低，在支架覆膜段近心端补放裸支架1枚，其余病例均与模拟结果相同。结论 在患者个体化术区结构三维模型基础上进行的术前模拟具有较高的逼真度，模拟结果能较准确地指导实际操作，对于提高手术成功率和培养年轻医师具有实用价值。Objective To establish virtual three-dimensional models of interventional devices and individualized surgical area structure in transjugular intrahepatic portosystemic shunt （TIPS） treatmentland to explore the value of virtual models for preoperative simulation in TIPS treatment. Methods Thin slice scan data of 8 patients with supine upper abdomen were obtained, three dimensional structures of bone,liver,portal vein,inferior vena cava and hepatic vein in CT scan area were reconstructed in Mimics software. According to the size of interventional instruments,a virtual RUPS-100 puncture kit and an VIATORR stent were established in 3D MAX software. Computer simulations were performed to evaluate the route from the hepatic vein puncture portal vein using the RUPS-100 puncture kit and VIATORR stent release position.Results （1）The establishment of individual three-dimensional model of patients was helpful for doctors to understand the spatial relation of hepatic vein and portal vein.（2）Through simulation, the puncture parameters of multi angle and multi position are obtained, which was helpful for the doctor to adjust the puncture direction according to the puncture point.（3）The position of the bare segment of the VIATORR stent in the portal vein was obtained by simulation, which was helpful for evaluating the length of the stent.@The preoperative simulation results included the simulation parameters for each patient puncture into left portal vein, right portal vein and portal vein bifurcation.In the actual operation, we punctured into the portal vein bifurcation in 4 cases,into the right branch in 2 cases and into the left in 2 cases.QPreoperative simulations were performed using 8 mmX 6 cmN 2 cm size VIATORR stent.Howere,the actual operation of the first case was lack of experience,and the stent position was lower,then we released a bare stent at the proximal end of the VIATORR stent.The rest of the cases were the same as the simulation results.Conclusion According to the three-dimensional model of the

关 键 词：门静脉高压症 经颈静脉肝内门体分流术 三维重建 模拟 

分 类 号：R543.6[医药卫生—心血管疾病] R815[医药卫生—内科学]