增强现实辅助电磁导航下的内镜逆行胰胆管造影胆管插管定位技术模型研究  

Positioning accuracy evaluation of augmented reality-assisted navigation system for endoscopic retrograde cholangiopancreatography intubation in a phantom model

作　　者：张大涯 杨硕[3] 吴浪 令狐恩强[2] 李明阳[2] ZHANG Daya;YANG Shuo;WU Lang;LINGHU Enqiang;LI Mingyang(Graduate School,Chinese PLA General Hospital,Beijing 100853,China;Department of Gastroenterology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Beijing Engineering Research Center of Mixed Reality and Advanced Display,Beijing Institute of Technology,Beijing 100081,China)

机构地区：[1]解放军总医院研究生院,北京100853 [2]解放军总医院第一医学中心消化内科,北京100853 [3]北京理工大学混合现实与新型显示工程技术研究中心,北京100081

出　　处：《解放军医学院学报》2021年第11期1188-1191,F0003,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家重点研发计划(2018YFA0208902)。

摘　　要：背景内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术者时常会面临选择性肝内胆管超选困难的问题,且反复尝试插管大大增加了术后并发症的发生率。近年来,增强现实(augmented reality,AR)辅助电磁导航已成为微创手术的重要辅助工具。目的探讨增强现实辅助电磁导航引导ERCP胆管插管在3D打印胆道模型中的定位精度。方法将1例肝内外胆管扩张患者腹部CT图像中的胆道进行三维重建,将结果通过3D打印生成一个1∶1.36的胆道树脂模型。在胆道模型内嵌入标记物作为导航精度测量的"靶点",并固定在人体腹部体模中。在体模基底和皮肤表面分别贴上配准标志物和标记物。对体模行CT平扫,得到体模的标准三维图形文件(STL)。在乳头括约肌切开刀通道内部安装一个电磁传感器,用于追踪其在模型中的位置,并使用图像叠加构建一个增强现实导航平台。通过术前CT扫描获得体模配准标志物和标记物的图像坐标,实验中再获取其磁场坐标,完成术前、术中配准和增强现实精度分析。结果在体模上行ERCP胆管插管,在AR辅助电磁导航下乳头括约肌切开刀被准确引导进入左右肝管,导航精度误差为(0.949±0.033) mm,可达到临床应用的要求。结论模型实验证实了AR辅助电磁导航ERCP胆管插管的可行性,为其进一步在临床应用奠定了基础。Background Endoscopic retrograde cholangiopancreatography(ERCP) operators often face the difficulty in intubation of selective intrahepatic bile ducts. Repeated attempts at intubation greatly increase the occurrence of postoperative complications. In recent years, the use of augmented reality-assisted electromagnetic tracking for navigation during surgery has become an important auxiliary tool in minimally invasive surgery. Objective To explore the positioning accuracy of using augmented reality-assisted electromagnetic navigation to guide ERCP bile duct intubation based on a three-dimensional(3D) printing model. Methods Threedimensional reconstruction of the abdominal CT data of a patient with choledocholithiasis accompanied by dilation of biliary tract was performed, and a 1 : 1.36 biliary tract model was generated by 3D printing. After the biliary model was embedded with the marked model as the “target” for navigation accuracy measurement, it was fixed in the human abdomen phantom. The abdomen phantom was pasted with marked models, then the phantom was scanned by CT and STL of the phantom was obtained by segmentation. An electromagnetic sensor was installed inside the channel of sphincterotomy to track its movement in the channel of the 3D printed model, and an augmented reality navigation platform was constructed using image overlay display. The image coordinates of markers outside the abdomen phantom through the preoperative CT scan and the magnetic field coordinates of markers during the operation were obtained to complete operative registration and augmented reality accuracy analysis. Results The sphincterotomy was accurately guided into the left and right hepatic ducts under the AR-assisted electromagnetic navigation with navigation accuracy error of(0.949±0.033) mm, which could meet the requirement of clinical application. Conclusion The model experiment confirmed augmented reality technology-assisted electromagnetic navigation can be used as an auxiliary means of ERCP bile duct intubation, which la

关 键 词：内镜逆行胰胆管造影 电磁导航 增强现实技术 胆管扩张 三维重建 3D打印模型 

分 类 号：R657.4[医药卫生—外科学]