三维可视化、虚拟现实技术联合ICG分子荧光成像在中央型肝癌肝切除术中的应用(附视频)  

Application of three-dimensional visualization, virtual reality combined with indocyanine green molecular fluorescence imaging in hepatectomy for central liver cancer (video attached)

作　　者：曾思略 杨剑[1] 祝文[1] 文赛 张可 方驰华[1] Zeng Silue;Yang Jian;Zhu Wen;Wen Sai;Zhang Ke;Fang Chihua(Department of Hepatobiliary Surgery,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,China;Chengdu Co-innovation Technology Co.,Ltd.,Chengdu 610000,China)

机构地区：[1]南方医科大学珠江医院肝胆一科,广州510282 [2]成都中创五联科技有限公司,610000

出　　处：《中华肝脏外科手术学电子杂志》2019年第5期420-425,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

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(81627805);国家科学基金青年基金(81601576);NSFC-广东联合基金项目(U1401254);广东省科技计划项目(2016A020220013,2017ZC0110);广州市科技计划项目(201604020144,201704020141)

摘　　要：目的探讨三维可视化、虚拟现实(VR)技术联合吲哚氰绿(ICG)分子荧光成像在中央型原发性肝癌(肝癌)肝切除术中的应用价值。方法本研究对象为2018年7月南方医科大学珠江医院行肝中叶切除术的1例中央型肝癌患者。患者男,27岁,因“体检发现肝脏占位2 d”入院。患者已签署知情同意书,符合医学伦理学规定。利用三维可视化及VR技术行术前评估及手术规划,术中应用ICG分子荧光成像结合无血管阻断技术进行肝中叶切除术。结果三维可视化重建后,各个器官显示良好,能多角度清晰显示肝脏形态、肿瘤与肝内脉管组织的毗邻关系、肝内各重要脉管走行;肝总动脉变异发自肠系膜上动脉。VR模型显示肿瘤位于Ⅳa、Ⅴ、Ⅷ段。肿瘤大小约11.5 cm×11.1 cm×8.5 cm,紧贴肝右静脉主干,肝中静脉根部1 cm被肿瘤侵犯,连续性中断。术前三维可视化及VR模型与术中所见相符,术前规划与实际手术一致。患者术后恢复良好,术后3个月复查CT及三维可视化重建见肝中叶已切除,肝中静脉缺如,肝左、右静脉血供良好,未见肿瘤残余或复发。结论三维可视化、VR技术联合ICG分子荧光成像能对中央型肝癌肝切除术起到良好的辅助作用,结合无血管阻断肝切除术,可提高手术安全性,降低术后并发症的发生。Objective To explore the application value of three-dimensional visualization and virtual reality(VR)-assisted indocyanine green(ICG)molecular fluorescence imaging in hepatectomy for central liver cancer.Methods One patient diagnosed with central liver cancer who underwent mesohepatectomy in Zhujiang Hospital of Southern Medical University in July 2018 was recruited in this study.The 27-year-old male patient was admitted to our hospital due to"liver space-occupying lesion for 2 d in physical examination".The informed consent of the patient was obtained and the local ethical committee approval was received.Three-dimensional visualization and VR technology were performed for preoperative evaluation and surgical planning. ICG molecular fluorescence imaging combined with non-vascular occlusionwas applied during mesohepatectomy. Results With three-dimensional visualization, organs were welldisplayed. The liver morphology, the adjacent relationship between tumor and hepatic vessels, and thedistribution of important vessels could be clearly observed from multiple angles. The variation of commonhepatic artery originated from the superior mesenteric artery. VR model demonstrated that the tumor waslocated in the Ⅳa, Ⅴ and Ⅷ segments. The tumor was approximately 11.5 cm×11.1 cm×8.5 cm in size, andit closely adhered to the main of right hepatic vein, which was invaded for 1 cm at the root with continuousinterruption. Preoperative evaluation by the three-dimensional visualization and VR model matched withthe intraoperative findings. Preoperative surgical planning was in accordance with the actual operation. Thepatient recovered well after operation. CT scan and three-dimensional visual reconstruction at postoperative3 months showed that the middle lobe of liver was removed, the middle hepatic vein was absent, the left andright hepatic venous blood supply was in good condition, and no tumor residue or recurrence was found.Conclusions Three-dimensional visualization, VR combined with ICG molecular fluorescence imagingca

关 键 词：肝肿瘤 肝切除术 成像 三维 虚拟现实 吲哚花青绿 

分 类 号：R73[医药卫生—肿瘤]