肝门部胆管癌三维可视化诊治平台的构建及临床应用研究

发布时间：2018-11-24 09:35

【摘要】：研究背景肝门部胆管癌发病率呈上升趋势。手术切除是肝门部胆管癌治疗的最主要方式,实现肝门部胆管癌术前精准评估,优化其手术规划十分重要。近年来,随着数字医学技术的发展及三维可视化精准诊疗理念的推广和实践,国内外三维可视化技术、3D打印技术在医学领域的应用越来越多。三维可视化模型有助于肝门部胆管癌的精确诊断、术前评估和精准手术,逐步为肝胆外科医师所接受。目的:1、优化腹部增强CT扫描方法,获取高质量肝门部肿瘤病例亚毫米薄层螺旋CT数据;2、研究基于面绘制和体绘制相结合的三维重建方法,快速、高质量构建肝门部胆管癌三维可视化模型;3、构建肝门部胆管癌三维可视化诊治平台,制定平台管理流程并探讨其临床意义;4、探讨三维可视化技术在术前评估肝门部胆管癌外科治疗的临床应用价值及意义。方法:本课题通过回顾性病例分析,获取肝门部胆管癌患者CT数据;利用腹部医学图像三维可视化系统构建三维可视化模型,制定三维可视化诊治平台流程并探讨其临床意义;探讨三维可视化技术在术前评估肝门部胆管癌外科治疗的临床应用价值及意义。统计学处理:多种检查方法对形态学变化的检测和手术病理结果(金标准)进行χ2检验,采取均数±标准差显示符合正态分布的计量资料,选择SpSS19.0统计学APP对全部原始数据进行分析。结果:1.获取高质量亚毫米CT数据,构建三维模型立体感强,可清晰再现肝门部解剖结构的特点,成功构建肝门部胆管癌三维可视化诊治平台;2.三维可视化指导下进行肝门部胆管癌临床分型及可切除性评估和术前规划,尤其在肝内管道变异情况下指导手术规划,确定治疗方案,从而指导术中实际手术。3.术中检验三维可视化指导下肝门部胆管癌的个体化脉管分型结果和术中探查相一致。结论:1.高质量亚毫米CT数据能够提供人体腹部脏器和血管高分辨率的影像学特征,满足三维模型数据分割、三维重建的要求;2.肝门部肿瘤患者3D模型能对肿瘤的形态和部位及肝内各管道的空间解剖关系能作出准确系统全面的诊断,指导外科医生对肿瘤进行可切除性评估;3.肝门部肿瘤患者三维可视化诊治平台工作流程设计合理,具有临床应用示范价值。4.三维可视化技术对于肝门部胆管癌患者,通过术前手术规划,优化手术路径;尤其存在肝内胆管或血管变异时,术前通过观察三维可视化模型,可有效避免医源性损伤,为实现术前精准诊疗的一种创新方法,有一定的临床应用价值和前景。
[Abstract]:Background the incidence of hilar cholangiocarcinoma is on the rise. Surgical resection is the most important method in the treatment of hilar cholangiocarcinoma. In recent years, with the development of digital medicine technology and the promotion and practice of three-dimensional visualization accurate diagnosis and treatment, 3D visualization technology and 3D printing technology are applied more and more in the field of medicine at home and abroad. 3D visualization model is helpful for accurate diagnosis of hilar cholangiocarcinoma, preoperative evaluation and accurate operation, which is gradually accepted by hepatobiliary surgeons. Objective: 1. To optimize the method of abdominal enhanced CT scanning to obtain high quality submillimeter helical CT data of hepatic hilar tumors. 2. The 3D reconstruction method based on surface rendering and volume rendering is studied to construct the 3D visualization model of hilar cholangiocarcinoma quickly and qualitatively. (3) to construct a three-dimensional visual diagnosis and treatment platform for hilar cholangiocarcinoma, to establish the management process of the platform and to discuss its clinical significance; (4) to explore the clinical application value and significance of three-dimensional visualization technique in preoperative evaluation of surgical treatment of hilar cholangiocarcinoma. Methods: the CT data of patients with hilar cholangiocarcinoma were obtained by retrospective case analysis, the 3D visualization model of abdominal medical image was constructed, the procedure of 3D visualization diagnosis and treatment platform was established and its clinical significance was discussed. To evaluate the clinical value and significance of three-dimensional visualization technique in preoperative evaluation of surgical treatment of hilar cholangiocarcinoma. Statistical analysis: the morphologic changes and the results of surgery and pathology (gold standard) were examined by 蠂 2 test, and the mean 卤standard deviation was used to show the measurement data according to the normal distribution. SpSS19.0 statistical APP was selected to analyze all the original data. Results: 1. Acquiring high quality submillimeter CT data and constructing three-dimensional model can clearly reproduce the characteristics of hepatic hilar anatomical structure and successfully construct a three-dimensional visual diagnosis and treatment platform for hilar cholangiocarcinoma. 2. Under the guidance of 3D visualization, the clinical classification, resectability evaluation and preoperative planning of hilar cholangiocarcinoma were carried out, especially in the case of intrahepatic duct variation, the operative planning was guided, and the treatment plan was determined, so as to guide the actual operation during the operation. The results of individualized vessel classification of hilar cholangiocarcinoma guided by three-dimensional visualization were consistent with intraoperative exploration. Conclusion: 1. High-quality submillimeter CT data can provide high resolution imaging features of human abdominal organs and blood vessels and meet the requirements of 3D model data segmentation and 3D reconstruction. 2. The 3D model of hepatic hilar tumor can make accurate and systematic diagnosis of the shape and location of the tumor and the spatial anatomical relationship of the hepatic ducts, and instruct the surgeon to evaluate the resectability of the tumor. 3. The workflow of the three-dimensional visual diagnosis and treatment platform for hilar tumor patients is reasonable and has the value of clinical application demonstration. 4. For patients with hilar cholangiocarcinoma, three dimensional visualization technique was used to optimize the operation path by preoperative operation planning. Especially in the presence of intrahepatic bile duct or vascular variation, preoperative observation of three-dimensional visual model can effectively avoid iatrogenic injury, in order to achieve preoperative accurate diagnosis and treatment of an innovative method, has a certain clinical application value and prospects.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R735.8

【相似文献】