CT三维重建肾集合系统解剖对PCNL术前穿刺定位的应用研究

发布时间：2018-05-08 16:48

本文选题：三维重建 + 解剖　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：通过CT三维重建肾脏集合系统的解剖分析集合系统的分型，以及集合系统在体表的投影位置，为经皮肾镜碎石术的非实时同步定位进行目标盏穿刺提供指导，简化术中定位操作、避免医患X-ray等过多的放射性损害，达到缩短PCNL的学习曲线。方法：于2012年9月至2013年7月期间在广西医科大学第一附属医院西院行GE公司Lightspeed多层螺旋CT机增强扫描并进行三维重建的患者，，总数为50例肾脏数据，其中分别男23例肾脏，女27例肾脏，左侧25例肾脏，右侧25例肾脏，健康肾脏15例，积水患病肾脏13例，非积水患病肾脏22例。 1、采用德国的GE公司出的Volume viewer三维重建软件工作站，并首先通过增强并三维重建的扫描图像结果使用立体容积再现(V R)、3D影像的最大密度投影(3D-MIP)、影像的多平面再重建(MPR)、图像立体曲面重建(CPR)等图像三维重建技术最后形成的肾集合系统内部解剖结构的三维图像。 2、仔细观察肾脏集合系统的三维重建图像，通过旋转测量角度、放大局部结构、多次剪裁、旋转观察等图像处理。分析肾脏空间解剖特征，并对肾脏空间各个倾斜度、肾盂与肾盏及肾各大盏之间夹角、肾盏宽度和长度，计数肾小盏数量等数据测量、记录。 3、上述数据均是采用SPSS19.0软件、 Microsoft Excel软件对所测量数据进行统计学分析。结果：CT三维重建肾脏集合系统的解剖图像显示：1.肾脏中盏距离肾盂的路径最短（即中盏的盏长径最短），可向外辐射上、下盏相对面积大，肾中盏后组长轴几乎垂直肾脏的长轴，且到达体表的距离较上、下盏长度短。2.右侧肾脏大多数为成熟型（52.2%），左侧肾脏大多数为分支型（50%）。正常肾脏集合系统分型大多数为不确定型（其中左侧肾脏为60%，右侧肾脏为60.9%），左侧肾脏HODSON型较多，占左肾总数32%，右侧肾脏BRODEL型较多，占右肾总数26%。3．患肾积水的集合系统形态学改变，一般分两种类型分别是融合型与调色板型。4.约93%左侧肾脏的集合系统上端边缘在第11胸椎下缘水平，下部边缘第3腰椎下缘以上，右侧肾脏集合系统上端边缘稍低，位于第12胸椎上缘以上，下端平第3腰椎上缘；约63%肾脏的肾盂在体表皮肤的投影在第1腰椎与第2腰椎得横突区域；72%以上肾脏的中盏后组投影位于第11肋间隙末端向内约1.5-2.5cm范围内。结论：1、CT三维重建后的图像显示肾中盏后组有距体表较近、肾脏横断面的辐射面积广、进入上下盏清石容易等优点使其可作为经皮肾镜取石术的最佳目标盏，达到单通道清石率最高，且损伤最小。 2、术前CT三维重建肾脏集合系统解剖可以做到非实时同步定位进行穿刺建立通道，减少对使用C臂等繁琐操作的依赖性，减少X-ray对人体不必要的损害，对缩短PCNL的学习曲线有一定的帮助。
[Abstract]:Objective: to analyze the classification of the collection system and the projection position of the collection system in order to provide guidance for the non-real-time simultaneous localization of the target calyceal puncture in percutaneous nephrolithotripsy (percutaneous nephrolithotripsy). In order to shorten the learning curve of PCNL, the localization operation was simplified to avoid excessive radiation damage such as X-ray. Methods: from September 2012 to July 2013, a total of 50 patients (23 male, 23 male) underwent GE company Lightspeed multi-slice spiral CT enhanced scanning and 3D reconstruction in the Western Hospital of the first affiliated Hospital of Guangxi Medical University. There were 27 cases of female kidney, 25 cases of left kidney, 25 cases of right kidney, 15 cases of healthy kidney, 13 cases of hydronephrosis and 22 cases of non-hydronephrosis. 1. The 3D reconstruction software workstation of Volume viewer, which is produced by GE Company of Germany, is adopted. First of all, the 3D reconstruction technology was used to reconstruct the final shape of the 3D images by using 3D volume reconstruction, the maximum density projection 3D-MIP, the multi-plane reconstruction MPRP, the 3D curved surface reconstruction of the image CPR, and so on, through the results of the enhanced and 3D reconstruction of the scanning images by using the three-dimensional volume reconstruction technique, such as the maximum density projection of the 3D image and the multi-plane reconstruction of the image. A three-dimensional image of the anatomical structure of the renal ensemble system. (2) the 3D reconstruction images of the renal collection system are carefully observed, and the image processing is carried out by measuring the angle of rotation, enlarging the local structure, cutting many times, rotating observation and so on. The spatial anatomical characteristics of the kidney were analyzed, and the data of each inclination of renal space, the angle between renal pelvis and calyces, the width and length of renal calyces, and the number of calices were measured and recorded. 3. The above data were analyzed statistically by SPSS19.0 software and Microsoft Excel software. Results the anatomical image of the three-dimensional reconstruction of the renal collection system showed the image of 1: 1. The path from the middle calyx to the renal pelvis is the shortest (that is, the calyceal length of the middle calyceal, the shortest diameter, the relative area of the lower calyceal is large, the length of the lower calyx is shorter than that of the body surface, and the length of the lower calyx is shorter. Most of the right kidneys were mature and the left kidneys were mostly branched. Most of the normal renal aggregate system types were uncertain (60 in the left kidney, 60 in the right kidney, 60 in the left kidney, 32 in the total number of the left kidney, and 26. 3 in the right kidney). The morphological changes of collecting system of hydronephrosis were divided into two types: fusion type and palette type. 4. About 93% of the upper edge of the collecting system of the left kidney was at the level of the lower edge of the 11th thoracic vertebra, the lower edge of the third lumbar vertebra was above the lower edge of the third lumbar vertebra, and the upper edge of the right renal collecting system was slightly lower, which was located above the upper edge of the 12th thoracic vertebra and flattened at the lower end of the third lumbar vertebra. About 63% of the renal pelvis on the surface of the skin projected in the first lumbar vertebrae and the second lumbar vertebrae transverse process area more than 72% of the kidney in the middle calyceal group projection is located in the 11th intercostal space end inward about 1.5-2.5cm. Conclusion the three-dimensional reconstruction images of the middle calyceal group have the advantages of close to the body surface, wide cross-sectional radiation area, easy access to the upper and lower calyceal stones, and can be used as the best target for percutaneous nephrolithotomy. The stone removal rate of single channel is the highest, and the damage is minimum. 2. Three-dimensional CT reconstruction of renal collecting system anatomy before operation can achieve non-real-time simultaneous positioning for puncture to establish channels, reduce the dependence on the use of C-arm and other tedious operations, and reduce the unnecessary damage to human body caused by X-ray. It is helpful to shorten the learning curve of PCNL.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

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