在体盆腔淋巴结切除术数字化三维导航模型的构建和应用初步探讨

发布时间：2018-05-23 18:57

本文选题：在体 + 盆腔淋巴结切除术　；参考：《中国实用妇科与产科杂志》2015年01期

【摘要】：目的构建在体盆腔淋巴结切除术数字化三维导航模型,并探讨其在临床应用中的意义。方法通过采集1例2014年11月就诊于南方医科大学南方医院妇科拟接受腹腔镜手术治疗的Ⅰb1期宫颈癌患者的CT血管成像DICOM数据集,应用数字化三维重建技术构建该患者的骨盆、盆腔血管、腰大肌、淋巴结及闭孔神经等解剖结构,组建盆腔淋巴结切除术数字化三维导航模型,并应用于腹腔镜下盆腔淋巴结切除术的实时导航。结果成功地构建了在体盆腔淋巴结切除术数字化三维导航模型,并完成了术中实时导航。在导航模型的导引下,顺利完成盆腔淋巴结切除,同时避免了对变异闭孔静脉的损伤。术中通过比较发现所构建模型包括盆腔血管的走行及与周围组织如骨盆、腰大肌、淋巴结的关系和患者实际的盆腔解剖结构一致。重建双侧淋巴结24个,实际切除淋巴结31个。结论在体盆腔淋巴结切除术数字化三维导航模型可辅助术者在术前熟悉患者实体解剖结构及变异情况,实时指导手术实施,避免血管等重要组织的损伤,提高手术安全性和成功率。
[Abstract]:Objective to construct a digital three-dimensional navigation model of pelvic lymphadenectomy in vivo and discuss its clinical significance. Methods CT angiography (DICOM) data sets were collected from a gynecological department of Southern Hospital of Southern Medical University of Southern China in November 2014. The pelvis of the patient was constructed by using digital three-dimensional reconstruction technique. The digital three-dimensional navigation model of pelvic lymphadenectomy was established by using the anatomical structures of pelvic vessels, psoas major muscles, lymph nodes and obturator nerve, and was applied to real-time navigation of laparoscopic pelvic lymphadenectomy. Results the digital three-dimensional navigation model of pelvic lymphadenectomy in vivo was successfully constructed and real-time navigation was completed. Guided by the navigation model, pelvic lymphadenectomy was successfully completed, and the damage to the variant obturator vein was avoided. Intraoperative comparison revealed that the constructed model included the path of pelvic vessels and the relationship with surrounding tissues such as pelvis, psoas major muscle, lymph nodes and the actual pelvic anatomical structure of the patients. Twenty-four bilateral lymph nodes were reconstructed and 31 were actually resected. Conclusion the digital three-dimensional navigation model of pelvic lymphadenectomy in vivo can help the patients to know the anatomical structure and variation of the patient before operation, to guide the operation in real time, and to avoid the injury of important tissues such as blood vessels. To improve the safety and success rate of operation.
【作者单位】：南方医科大学南方医院妇产科;南方医科大学南方医院影像中心;南方医科大学基础医学院解剖学教研室;
【基金】：国家自然科学基金(81272585) 广东省自然科学基金(S2011010003830)
【分类号】：R737.33

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