术前模拟在经颈静脉肝内门体静脉分流术治疗中的价值  

Value of preoperative simulation in the treatment of transjugular intrahepatic portosystemic shunt

作　　者：魏欣[1] 胡鸿[1] 钟立明[1] 游箭[1] WEI Xin;HU Hong;ZHONG Liming;YOU Jian(Department of Interventional Radiology,Nanchong Central Hospital,Second Clinic Institute of North Sichuan Medical College,Nanchong,Sichuan 637000,P.R.China)

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

出　　处：《中国普外基础与临床杂志》2019年第12期1424-1428,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生计生委科技项目2018年立项项目（项目编号：18PJ393)

摘　　要：目的评价患者个体化的术前模拟在经颈静脉肝内门体分流术(TIPS)治疗中的价值。方法在Mimics软件中重建39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,在计算机上进行经肝静脉穿刺门静脉路径和支架释放位置的术前模拟,对比模拟参数与实际手术结果的符合程度。结果①术前模拟过程的时间可控,总共模拟时间70~110 min(总结前期经验后),日常工作中不会影响治疗进度。②术中穿刺门静脉分叉部4例、左支22例、右支13例(术前模拟计划穿刺左支24例,右支15例),总体符合率为89.7%(35/39)。③术前模拟均采用8 mm×6 cm/2 cm规格的VIATORR支架,实际手术中采用的支架均与模拟结果相同。④术前模拟和术后回顾性模拟能够缩短教学和培训时间,加强学员对手术意图和关键步骤的理解。结论基于患者个体化三维模型和虚拟介入器械的术前模拟能较准确地指导TIPS的实际操作,对于提高手术成功率和培养年轻医师具有实用价值。Objective To evaluate the value of individualized preoperative simulation in transjugular intrahepatic portosystemic shunt(TIPS).Methods Thin slice scan data of 39 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 and stent release position.The coincidence of simulation parameters with actual surgical results was compared.Results①The time of preoperative simulation was controllable.The total simulation time was 70–110 minutes(after summing up the previous experience).Preoperative simulation in daily work would not affect the progress of treatment.②There were 4 cases of puncturing bifurcation of portal vein,22 cases of puncturing left branch and 13 cases of puncturing right branch during operation(24 cases of puncturing left branch and 15 cases of puncturing right branch by preoperative simulation plan).The overall coincidence rate was 89.7%(35/39).③Preoperative simulations were performed using 8 mm×6 cm/2 cm size VIATORR stents,and the stents used in the actual operation were the same as the simulation results.④Preoperative simulation and post-operative retrospective simulation could shortened the teaching and training time and enhanced the understanding of surgical intention and key steps.Conclusion Preoperative simulation based on patient's individualized three-dimensional model and virtual interventional device could guided the actual operation of TIPS more accurately,and had practical value for improving the success rate of operation and training young doctors.

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：R47[医药卫生—护理学]