以血管为轴心的中央型肝癌三维可视化评估及虚拟现实的研究  

Three-dimensional visual assessment and virtual reality study of centrally located hepatocellular carcinoma on the axis of blood vessels

作　　者：祝文[1] 何松盛 曾思略 张鹏[1] 杨剑[1] 项楠[1] 曾宁[1] 范应方[1] 文赛 方驰华[1] 张可 Zhu Wen;He Songsheng;Zeng Silue;Zhang Peng;Yang Jian;Xiang Nan;Zeng Ning;Fan Yingfang;Wen Sai;Fang Chihua;Zhang Ke(First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University,Guangdong Provincial Clinical and Engineering Center of Digital Medicine,Guangzhou 510282,China;Co-innovation (Chengdu) Technology Company,Ltd.,Chengdu 610000,China)

机构地区：[1]南方医科大学珠江医院肝胆一科广东省数字医学临床工程技术研究中心,广州510282 [2]成都中创五联科技有限公司,610000

出　　处：《中华外科杂志》2019年第5期358-365,共8页Chinese Journal of Surgery

基　　金："十三五"国家重点研发计划数字诊疗装备研发重点专项(2016YFC0106500);国家自然科学基金重大科研仪器研制项目(81627805);国家高技术研究发展计划(863计划)(2012AA021105,2006AA02Z346);国家自然科学基金和广东省联合基金项目(U1401254);广东省科技计划项目(2017ZC0110,2016A020220013);广州市科技计划项目(201604020144).

摘　　要：目的研究一种基于三维可视化及虚拟现实(VR)的以血管为轴心的术前精确评估中央型肝癌的新方法及其应用价值。方法回顾性收集2017年3月至2018年7月南方医科大学珠江医院肝胆一科收治的经术前检查诊断为中央型肝癌的20例患者的高质量CT图像数据。男性18例,女性2例,年龄28~69岁。所有患者肝功能Child-Pugh分级均为A级。首先采用三维可视化软件对影像学资料进行三维重建,然后导入VR开发引擎进行VR的研究,在三维可视化中央型肝癌分型基础上建立以血管为轴心的分析和评估体系,精确判断肿瘤与周围主要血管的关系,制定手术规划,并将二者图像带入手术室用于指导导航手术。比较20例患者术前资料评估结果及VR环境中以血管为轴心的三维可视化评估结果,记录术前术后血红蛋白、血清白蛋白、胆红素数值并进行对比。计数资料分析采用χ2检验,符合正态分布的计量资料比较采用t检验,非正态分布的计量资料比较采用非参数检验。结果20例中央型肝癌患者均成功进行了三维重建,按照中央型肝癌三维可视化分型结果如下:Ⅰ型3例,Ⅱ型1例,Ⅲ型4例,Ⅳ型7例,Ⅴ型5例。以血管为轴心评估分型结果如下:Ⅰa型6例、Ⅰb型2例、Ⅱa型2例、Ⅱb型9例、Ⅱc型1例。所有患者均在三维可视化及VR指导下成功切除肿瘤,术前CT和(或)MRI评估结果与术中所见相符15例,符合率为75.0%(15/20);在VR环境中以血管为轴心的三维可视化评估与术中探查所见均一致,符合率为100%(20/20),两者差异有统计学意义(χ2=5.714,P=0.017)。本组所有患者手术过程中均未输红细胞,术前血红蛋白为(128.8±14.9)g/L,术后第1天血红蛋白为(119.8±12.5)g/L,术前术后血红蛋白的差异无统计学意义(t=2.07,P=0.054)。患者围手术期无死亡,术后未发生肝功能衰竭、出血、胆瘘等并发症。结论基于三维可视化及VR的以血管为轴心的术�Objective To explore a novel method for preoperative precision assessment of centrally located hepatocellular carcinoma(HCC) with blood vessel as axis based on three-dimensional(3D) visualization and virtual reality(VR) technology and its application values. Methods High-quality thin-layer enhanced CT data were collected from 20 patients with centrally located HCC who treated at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from March 2017 to August 2018 diagnosed by preoperative examination. There were 18 males and 2 females, aged 28 to 69 years, all of Child-Pugh grade A. First of all, 3D reconstruction was performed by a 3D visualization software;then, the reconstructed 3D image was imported into VR development engine for VR research;afterwards, the analysis and evaluation system with blood vessel as axis was established based on 3D visualization classification of centrally located HCC;therefore, the relationship of the tumor to its major peripheral blood vessels was accurately judged and the surgical planning was formulated. Two images were brought into the operating room for navigation in surgery. The assessments results of preoperative data (CT and (or) MRI) and three-dimensional visualization of blood vessels in VR environment were compared;the values of the preoperative and postoperative hemoglobin, serum albumin and bilirubin were recorded and compared. Chi-square test, t-test and non-parametric test were used for the analysis of counting data, continuous measurement data and non-normal distribution measurement data, respectively. Results 3D visualization modeling was completed in all of the 20 patients with centrally located HCC. According to the results of 3D visualization classification of centrally located HCC, there were 3 cases of type Ⅰ,1 case of type Ⅱ,4 cases of type Ⅲ,7 cases of type Ⅳ and 5 cases of type Ⅴ;according to the assessment and classification based on blood vessel as the axis, there were 6 cases of type Ⅰa,2 cases of type Ⅰb,2

关 键 词：肝肿瘤 成像 三维 血管轴心 虚拟现实 术前评估 中央型肝癌 

分 类 号：R735.7[医药卫生—肿瘤]