数字化三维重建技术在指导腹主动脉旁淋巴结切除术中的应用

发布时间：2018-06-06 22:35

本文选题：三维重建 + 腹主动脉　；参考：《妇产与遗传(电子版)》2016年04期

【摘要】：目的应用数字化三维重建技术构建腹部大血管三维模型并对模型进行解剖学测量,从而探讨其在腹主动脉旁淋巴结切除术中的指导价值。方法选取2012年9月~2014年5月在南方医科大学南方医院行腹盆腔CT血管成像检查(Computed tomo-angiography,CTA)的患者251例,构建腹盆腔大血管数字化三维模型,利用mimics软件坐标定位法分别测量并记录在肾动脉水平、肠系膜下动脉水平腹主动脉右侧壁与下腔静脉左侧壁之间的水平距离,以及腹主动脉分叉点与左右髂总静脉汇合点间的上下距离,并以10 mm间距为一类进行分类统计。结果应用数字化三维重建技术成功构建腹主动脉与下腔静脉模型,其中有两例数据存在变异,一例为左下腔静脉、一例为双下腔静脉,其他249例数据腹主动脉和下腔静脉未见明显变异。按照三个水平进行测量,下腔静脉和腹主动脉的最小水平间距为0,在肾动脉水平(n=177),腹主动脉与下腔静脉间距离(a)最大为62.8 mm,最多见类型为间距1~2 cm组,占53.10%;在肠系膜下动脉水平(n=238),二者最大间距为33.81 mm,最多见类型为0~1 cm组,占59.20%;而在髂总动脉分叉点水平(n=238),二者间最大距离是49.74 mm,最多见类型为2~3 cm组,占47.40%;结论采用数字化三维重建技术可成功构建在体腹部大血管三维模型,并依此进行三维解剖测量。腹主动脉与下腔静脉的变异情况并不多见,二者之间的间距在不同水平大小不一,肾动脉水平1~2 cm为主,肠系膜下动脉水平0~1 cm为主,而髂总动脉分叉水平以2~3 cm为主,既有规律性又有特异性,术前三维模型可以协助了解二者的精确位置,增加术者术中对腹主动脉与下腔静脉空间关系的辨识度,并快速定位,从而减少医源性血管、脏器的损伤,增加腹主动脉旁淋巴结切除手术的安全性,也为今后大体解剖学测量提供新思路。
[Abstract]:Objective to construct a three-dimensional model of abdominal macrovascular by digital three-dimensional reconstruction and to measure the anatomy of the model, and to explore the guiding value of the model in para-aortic lymphadenectomy. Methods from September 2012 to May 2014, 251 patients underwent computed tomo-angiographic angiography (CTAA) in Southern Hospital of Southern Medical University. The horizontal distances between the right wall of the abdominal aorta and the left wall of the inferior vena cava were measured and recorded by mimics software coordinate positioning method at the level of renal artery, the level of inferior mesenteric artery, and the left wall of inferior vena cava. The upper and lower distance between the bifurcation point of abdominal aorta and the confluence point of left and right common iliac veins was classified and counted according to the distance of 10 mm. Results the models of abdominal aorta and inferior vena cava were successfully constructed by using digital 3D reconstruction technique. Two of them had data variation, one was left inferior vena cava and the other was double inferior vena cava. There was no significant variation in other 249 cases of abdominal aorta and inferior vena cava. The minimum horizontal distance between the inferior vena cava and the abdominal aorta was 0, the maximum distance between the abdominal aorta and the inferior vena cava was 62.8 mm at the renal artery level and the distance between the abdominal aorta and the inferior vena cava was 62.8 mm. At the level of inferior mesenteric artery, the maximum distance between them was 33.81 mm, the most common type was 0 ~ 1 cm group (59.20%), but at the level of common iliac artery bifurcation point, the maximum distance between them was 49.74 mm and the most common type was 23 cm group. Conclusion Three-dimensional reconstruction technique can be used to construct a three-dimensional model of the great vessels in the abdomen, and the three-dimensional anatomical measurement can be carried out according to it. The variation of abdominal aorta and inferior vena cava was rare. The distance between them was different at different levels. The renal artery level was 1 ~ 2 cm, the inferior mesenteric artery level was 0 ~ 1 cm, and the common iliac artery bifurcation level was 2 ~ 3 cm. The three-dimensional model before operation can help to understand the exact location of the two, increase the recognition of the spatial relationship between abdominal aorta and inferior vena cava during operation, and locate them quickly, thus reducing the iatrogenic blood vessels. The injury of viscera increases the safety of para-aortic lymphadenectomy, and provides a new idea for the measurement of gross anatomy in the future.
【作者单位】：陕西省妇幼保健院妇科;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;
【基金】：科技部十二五国家科技支撑项目(863预备项目:2014BAI05B03) 广州市科技计划健康医疗协同创新重大专项(201508020264) 国家自然科学基金(81370736,81571422)
【分类号】：R654.3

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