增强现实导航技术联合吲哚菁绿分子荧光影像在三维腹腔镜肝切除术中的应用  

Application of augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging in laparoscopic hepatectomy

作　　者：方驰华[1] 张鹏[1] 罗火灵[2] 祝文[1] 曾思略 胡浩宇 项楠[1] 杨剑[1] 曾宁[1] 范应方[1] 贾富仓[2] 刘连新 Fang Chihua;Zhang Peng;Luo Huoling;Zhu Wen;Zeng Silüe;Hu Haoyu;Xiang Nan;Yang Jian;Zeng Ning;Fan Yingfang;Jia Fucang;Liu Lianxin(Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China;Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China;Department of Hepatobiliary Surgery, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, 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]中国科学院深圳先进技术研究院,深圳518055 [3]中国科学技术大学附属第一医院肝胆外科,合肥230001

出　　处：《中华外科杂志》2019年第8期578-584,共7页Chinese Journal of Surgery

基　　金：国家重点研发计划数字诊断与治疗装备研发重点专项(2016YFC0106500);国家自然科学基金(81627805);国家自然科学基金-广东联合基金(U1401254);国家高技术研究发展计划(863计划)(2006AA02Z346、2012AA021105);广东省自然科学基金(6200171);广州市科技计划项目(201604020144).

摘　　要：目的探讨增强现实导航技术联合吲哚菁绿(ICG)分子荧光影像在三维腹腔镜肝切除中的应用价值。方法回顾性收集2018年1月至2019年4月南方医科大学珠江医院肝胆一科收治的行三维腹腔镜肝切除术治疗的48例肝细胞肝癌患者的临床资料,导航组23例,利用自主研发的三维腹腔镜增强现实手术导航系统(软件著作权号:No.2018SR840555),将术前三维模型投影至手术视野,同时结合ICG荧光融合图像导航行三维腹腔镜肝切除术;常规25例,使用常规三维腹腔镜进行肝切除。患者均签署知情同意书,符合医学伦理学规定(伦理号:2018-GDYK-003)。收集并分析两组患者手术指标和并发症发生情况。分别采用t检验、Wilcoxon秩和检验、χ^2检验对临床数据进行统计学分析。结果导航组术中中位出血量为250(200)ml[M(QR)],少于常规组的300(150)ml(Z=-2.307,P=0.021)。导航组术中输血率为13.0%(3/23),少于常规组的40.0%(10/25)(χ^2=4.408,P=0.036)。导航组中位术后住院时间为8(2)d,短于常规组的11(6.5)d(Z=-2.694,P=0.007)。两组患者均无严重并发症发生及围手术期死亡。导航组患者术后并发症发生率为17.4%(4/23),与常规组的28.0%(7/25)相比,差异无统计学意义(χ^2=0.763,P=0.382)。结论三维腹腔镜肝切除术中应用增强现实导航技术联合ICG分子荧光影像具有良好的治疗效果。Objective To study the application value of augmented-reality (AR) surgical navigation technology combined with indocyanine green (ICG) molecular fluorescence imaging in three-dimensional (3D) laparoscopic hepatectomy. Methods The clinical data of forty-eight patients who had undergone 3D laparoscopic hepatectomy for hepatocellular carcinoma at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from January 2018 to April 2019 were retrospectively analyzed.The patients were divided into two groups: the group of 3D laparoscopic hepatectomy navigated by augment reality technology combined with ICG molecular fluorescence imaging (Group A), and group of conventional 3D laparoscopic hepatectomy (Group B). Patients in Group A (n=23) underwent 3D laparoscopic hepatectomy using augmented-reality technology combined with ICG molecular fluorescence imaging. In this group, the self-developed three-dimensional laparoscopic augmented-reality surgical navigation system (No. 2018SR840555) was operated to project the preoperative three-dimensional model to the surgical field, and the use of this system in combination with ICG molecular fluorescence imaging navigated laparoscopic hepatectomy. No surgical navigation technology was applied in Group B (n=25). All patients signed the informed consent, which were in accordance with the requirements of medical ethics (Ethics No.: 2018-GDYK-003). The preoperative data, surgical indicators and postoperative complications between the two groups were compared and analyzed. Results The median amount of intraoperative blood loss of Group A was 250 (200) ml (M (QR)), which was significantly lower than that of Group B (300 (150) ml)(Z=-2.307, P=0.021).The transfusion rate of Group A was 13.0%(3/23), which was significantly lower than that of Group B (40.0%, 10/25)(χ^2=4.408, P=0.036).The median postoperative hospitalization time of Group A was 8 (2) d, which was significantly shorter than that of Group B (11 (6.5) d)(Z=-2.694, P=0.007). There were no seri

关 键 词：肝肿瘤 成像 三维 增强现实 吲哚菁绿 腹腔镜肝切除术 

分 类 号：R657.3[医药卫生—外科学]