| 王东文,张彬,原小斌,张旭辉,刘晨.基于个体化三维仿真模型的手术规划导引技术在后腹腔镜肾上腺嗜铬细胞瘤切除术中的应用[J].中国医学影像技术,2015,31(4):581~585 |
| 基于个体化三维仿真模型的手术规划导引技术在后腹腔镜肾上腺嗜铬细胞瘤切除术中的应用 |
| Application of preoperative planning and real-time navigation by three-dimensional individual digital model in retroperitoneal laparoscopic adrenalectomy for pheochromocytoma |
| 投稿时间：2014-06-13 修订日期：2014-10-22 |
| DOI：10.13929/j.1003-3289.2015.04.027 |
| 中文关键词: 体层摄影术,X线计算机 成像,三维 仿真 手术规划 导引 腹腔镜 嗜铬细胞瘤 |
| 英文关键词:Tomography, X-ray computed Imaging,three-dimensional Simulation Surgical planning Guidance Laparoscopic Pheochromocytoma |
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| 中文摘要: |
| 目的 观察自主研发的个体化三维医学影像重建与导引系统(3D-MIRGS)在后腹腔镜下嗜铬细胞瘤切除术中的临床应用价值。方法 将23例诊断为肾上腺嗜铬细胞瘤拟行后腹腔镜手术患者的腹部64层螺旋CT薄层增强扫描数据导入3D-MIRGS,进行计算机与人工矫正相结合、多时相数据相补充模式下的图像分割、重建及融合,在与传统CT后处理技术(VR)图像对比的基础上根据所获得的肾上腺及瘤体个体化数字模型观察肾上腺中央静脉的走行、毗邻等情况以及瘤体与周围器官的立体解剖关系,制定术前规划,并在术中完成精确实时定位导引。结果 23例患者均由3D-MIRGS成功构建个体化数字模型,与VR图像对比可同期一体化更清晰显示患侧肾上腺中央静脉及瘤体的形态与边界。个体化三维数字模型成功为23例患者在后腹腔镜嗜铬细胞瘤切除术中完成了辅助导引,有效减少了血管探查造成的瘤体激惹,进而避免了术中出现血压大幅波动及出血相关性并发症。结论 3D-MIRGS可在后腹腔镜下嗜铬细胞瘤切除术前对肾上腺中央静脉做出清晰直观的空间定位诊断,并完成个体化手术方案规划及术中导引,可有效增加嗜铬细胞瘤手术安全性及成功率,减少围手术期并发症的发生。 |
| 英文摘要: |
| Objective To observe the application of preoperative planning and real-time navigation for retroperitoneal laparoscopic adrenalectomy for pheochromocytoma (RLA-PHEO) under the guidance of three-dimensional individual digital model (3D-IDM) created from self-developed software (three-dimensional medical image reconstructing and guiding system, 3D-MIRGS). Methods Totally 23 patients diagnosed as adrenal pheochromocytoma underwent retroperitoneal laparoscopic adrenalectomy. The data from dual-source 64-slice CT scanning was introduced into 3D-MIRGS for segmentation, reconstruction and image fusion under the mode of multiphase data integration and computer-assisted revision. Based on 3D-IDM, the origination and bifurcations of adrenal central vein were confirmed and the anatomical relationships between the tumors and nearby organs were also observed. Preoperative surgical plans were formulated based on the reconstructed 3D-IDM and intraoperative real-time navigations were performed under the guidance of 3D-IDM. Results The 3D-IDMs of 23 enrolled patients were all reconstructed successfully via 3D-MIRGS. Compared with the traditional CTA, 3D-IDMs can show clear images of adrenal central veins and tumors. The assisted navigation achieved successfully and avoided the irritation to tumor and intraoperatively hemodynamic fluctuations effectively. Conclusion Preoperative planning and real-time navigation by the 3D-IDM reconstructed on 3D-MIRGS can facilitate RLA-PHEO effectively and safely. |
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