肝脏静脉三维重建及肝内门体静脉分流术穿刺入路可视化研究

发布时间：2018-01-18 03:03

本文关键词：肝脏静脉三维重建及肝内门体静脉分流术穿刺入路可视化研究　出处：《第三军医大学》2007年博士论文　论文类型：学位论文

【摘要】： 肝脏是人体内体积最大、具有重要生理功能的脏器。肝脏管道系统的肝静脉系、门静脉系及肝后段下腔静脉的解剖结构交错重叠、相互关系复杂,是肝内血管介入治疗和肝脏手术切除的难点。经颈静脉肝内门体静脉分流术(Transjugular Intrahepatic Portosystemic Shunt, TIPS)是近年来发展起来的一项专门治疗门静脉高压症的介入放射学新技术,它采用多项介入技术,在门静脉和腔静脉之间通过介入器械搭建一个有效的静脉分流通道,使部分门静脉血流直接汇入下腔静脉而回流入心,治疗由于肝硬化等疾病所引起的门静脉高压。该技术操作的关键是准确掌握肝脏静脉管道间解剖结构的空间关系,设计适合导管介入治疗的路径,选择正确的穿刺点和适宜的分流通道,建立稳定而持久的肝内静脉分流途径,避免在手术操作中损伤毗邻的重要结构。本实验应用数字化可视人体数据集,选择自颈内静脉平面至肝脏下缘平面的连续薄层横断面图像序列,经精确配准后进行计算机图像重采样处理获取TIPS术路径的横断面、冠状断面和矢状断面三个方位的连续薄层断面图像数据集,并对各方位断面图像进行断层解剖学结构观察和数据测量;运用图像分割软件,采取对连续断面解剖结构追踪显示的方法,分别对数据集中的颈内静脉、头臂静脉、上腔静脉、心脏、下腔静脉、肝静脉和门静脉结构进行数据分割和边界提取,并在计算机上进行TIPS术路径及其改良术式-直接性门腔静脉分流术(Direct Intrahepatic Portacaval Shunt, DIPS)路径的三维重建,构建肝内门体分流三维模型,并观测和比较TIPS术与DIPS术路径的空间结构关系、穿刺路线和内支架位置;利用可视化软件,采用交互手动分割和自动阈值分割相结合的数据提取法进行图像分割,在图形工作站上完成经颈静脉肝内门体静脉分流术路径的三角形网格表面重构,构建肝内门体静脉分流的三维可视化模型,实现在可视化平台基础上进行立体观察和三维测量;应用虚拟内窥镜(Virtual Endoscopy, VE)技术,在肝内门体分流三维重建模型和可视化平台的基础上,进行经颈静脉至肝内门静脉管道内介入导管的虚拟内窥镜的漫游和观察,模拟介入穿刺针进行经肝静脉至肝内门静脉的门体静脉分流和经肝后段下腔静脉至肝内门静脉的门体静脉分流的虚拟穿刺。主要研究结果如下: 1.应用数字化可视人体数据集,选择自颈内静脉平面至肝脏下缘平面连续薄层横断面图像序列,经精确配准后完成计算机图像重采样,获取经颈静脉肝内门体静脉分流术路径的横断面、冠状断面和矢状断面三个方位的连续薄层断面的图像数据集,实现了对同一例标本进行多方位的断面图像信息获取。 2.在图像数据集上完成了对断层图像横断面、冠状断面和矢状断面多方位断层解剖结构的观察及比较,断面图像结构完整、图像清晰,阐明了各方位肝内静脉管道的形态学特点,并获取断面图像二维测量资料,为肝内门体静脉分流术提供断面解剖学形态依据。 3.运用图像分割软件,采取对连续断面解剖结构追踪显示模式,对经颈静脉肝内门体静脉分流术路径的主要结构进行了数据分割和边界提取,在计算机上构建了肝内门体静脉分流术路径的三维重建模型,观测并比较了TIPS术和DIPS术穿刺入路重建结构的空间关系,获取了穿刺路线和虚拟内支架三维数据,为肝内门体静脉分流术的穿刺入路提供了立体形态学依据。 4.利用可视化软件,采用手动交互分割和自动阈值分割相结合的图像数据提取方式在图形工作站上完成经颈静脉肝内门体静脉分流术路径的表面重构,构建了肝内门体静脉分流的三维可视化模型,实现了在可视化平台基础上的立体观察和三维测量,为肝内门体静脉分流术进一步深入研究提供了可视化平台和三维结构数据。 5.应用虚拟内窥镜技术,在肝内门体静脉分流术路径的三维可视化平台上,完成了肝脏静脉管道内介入导管的虚拟内窥镜漫游和观察,以内窥镜的视角清晰、生动地显示并描述了TIPS术路径和DIPS术路径管道内部结构特征。 6.在图形工作站上,模拟了介入手术穿刺针进行经肝静脉至肝内门静脉的门体静脉分流和经肝后段下腔静脉至肝内门静脉的门腔静脉分流的虚拟穿刺,演示了静脉穿刺入路的路径和过程,为建立肝脏血管内介入手术模拟训练系统奠定了基础。 7.依据肝内静脉管道特点,在三维可视化模型基础上设计了肝内门体静脉的介入导管的穿行路径和穿刺入路,比较了TIPS术和DIPS术路径穿刺入路的特点,为肝内门体静脉分流术提供了术前规划并制定合理的个性化介入手术方案的初步的计算机模型。
[Abstract]:Transthoracic Intrahepatic Portosystemic Shunt is a new technique for the interventional radiology of portal hypertension . Transthoracic Intrahepatic Portosystemic shunt ( transjugular intrahepatic portosystemic shunt ) is a new technique for the interventional therapy of portal hypertension . The three - dimensional visualization model of intrahepatic portacaval portacaval shunt ( DIPS ) is used to study and compare the three - dimensional reconstruction of portal vein , portal vein , superior vena cava , heart , inferior vena cava , hepatic vein and portal vein . 1 . The digital visual human data set is applied to select the continuous thin - layer cross section image sequence from the plane of the internal jugular vein to the lower edge of the liver , and after the accurate registration , the computer image is re - sampled , and the image data set of the cross section , the coronal section and the sagittal section of the jugular intrahepatic portal vein shunt path is acquired , and the multi - azimuth cross section image information acquisition is realized for the same specimen specimen . 2 . The cross section , coronal section and sagittal section multi - azimuth fault anatomical structure are observed and compared on the image data set . The section image structure is complete , the image is clear , the morphological characteristics of each azimuth hepatic vein duct are clarified , and the two - dimensional measurement data of the section image is acquired , which provides the basis for sectional anatomy for the hepatic portal vein shunt . 3 . Using image segmentation software , the main structure of portal vein shunt was divided and extracted . The three - dimensional reconstruction model of portal vein shunt was constructed on the computer . The spatial relationship between transjugular approach and DIPS was compared . The three - dimensional data of puncture route and virtual inner stent were obtained . 4 . Using the visualization software , the surface reconstruction of the portal vein shunt in the jugular intrahepatic portal vein is accomplished by using the image data extraction method combined with manual interaction segmentation and automatic threshold segmentation , and the three - dimensional visualization model of the hepatic portal vein shunt is constructed . The three - dimensional observation and the three - dimensional measurement on the visualization platform are realized , and the visualization platform and the three - dimensional structure data are further researched for further study of the hepatic portal vein shunt . 5 . Using virtual endoscopy technology , the virtual endoscopy and observation of the interventional catheter in the hepatic vein were completed on the three - dimensional visualization platform of the portal vein shunt pathway in the hepatic portal vein . 6 . On the graphic workstation , the virtual puncture of portal vein shunt and portal vein shunt through the portal vein in the hepatic vein to the intrahepatic portal vein were simulated . The path and procedure of vein puncture were demonstrated , which laid the foundation for the establishment of a simulated training system for hepatic vascular interventional procedure . 7 . On the basis of three - dimensional visualization model , the puncture path and the puncture approach of the interventional catheter of the hepatic portal vein were designed based on the characteristics of the hepatic vein , compared the characteristics of the transjugular approach and the DIPS path puncture approach , and provided a preliminary computer model for preoperative planning and the establishment of a reasonable personalized interventional procedure .

【学位授予单位】：第三军医大学
【学位级别】：博士
【学位授予年份】：2007
【分类号】：R322;R657.3

【引证文献】