肝脏个体化三维模型及虚拟肝切除在肝切除术的应用研究

发布时间：2018-02-25 19:05

本文关键词： 肝切除计算机辅助手术肝体积测量虚拟肝切除　出处：《南京大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨三维虚拟肝切除在临床肝切除术前规划中的应用价值。方法：搜集20例拟行肝切除患者的肝脏CT二维(2D)扫描数据,导入IQQA-liver肝脏三维手术模拟软件中进行肝肿瘤、肝实质、肝血管三维重建,生成个体化肝脏三维模型。由一名放射科医生分别在两名有经验的肝脏外科医生指导下行虚拟肝切除,并测量全肝体积、拟切除肝体积、残肝体积,以此指导肝切除手术规划的制定,并将模拟手术过程与真实的手术过程进行对比分析。将两次测量的拟切除肝体积进行相关性分析及均数比较。两次测量的拟切除肝体积分别与术中排水法测量的实际标本体积进行相关性分析。结果： 1.20例病人均成功进行了肝脏、肿瘤和肝内血管的三维分割、虚拟肝切除及手术规划。虚拟肝切除评估所有病灶均可被根治性切除,术前规划虚拟的图像与术中实际所见匹配良好。该软件还可进行基于门静脉灌注区及肝静脉引流区的定量评估,有利于术前预测肝缺血、淤血范围,并可提供静脉重建的一个定量标准。 2.两次测量拟切除肝体积之间显示呈显著正相关(相关系数r=0.998,P=0.000),并且两者均值差异无统计学意义(t=0.197,P=0.846)。两次拟切除肝体积和实际排水法测得标本肝体积呈显著正相关(相关系数r1=0.966,P：0.000；r2=0.971,P=0.000)。 3.该软件重建肝脏、血管、肿瘤的融合图像耗时约40-50分钟左右,进一步的虚拟肝切除每例病人耗时约20-30分钟左右。结论：IQQA-liver应用于肝切除术前规划可获得个体化的肝脏及其血管结构的解剖学信息。虚拟肝切除可较为准确的预测拟切除肝体积和残肝体积。此软件的应用将对完善术前精确评估及保障术中手术安全起到重要作用。
[Abstract]:Objective: to explore the application value of three-dimensional virtual hepatectomy in the planning of clinical hepatectomy. Methods: the CT 2D scan data of 20 patients with hepatectomy were collected, and the three-dimensional reconstruction of liver tumor, hepatic parenchyma and hepatic vessels were performed by IQQA-liver liver surgery simulation software. A three-dimensional model of the individual liver was created. A radiologist conducted a virtual hepatectomy under the guidance of two experienced liver surgeons, and measured the total liver volume, the intended liver volume, the residual liver volume. To guide the planning of hepatectomy, The simulated operation process and the real operation process were compared and analyzed. The correlation analysis and the mean value of the liver volume measured twice were compared with those measured by the drainage method. The correlativity of actual specimen volume was analyzed. Results:. 1.Twenty patients were successfully divided into three dimensions of liver, tumor and intrahepatic vessels, virtual hepatectomy and surgical planning. All lesions were evaluated by virtual hepatectomy for radical resection. The virtual images of preoperative planning match well with the actual results during operation. The software can also be used for quantitative evaluation based on portal vein perfusion area and hepatic venous drainage area, which is helpful to predict the extent of hepatic ischemia and congestion before operation. It can also provide a quantitative standard for venous reconstruction. 2. There was a significant positive correlation between the volume of the liver to be resected twice (r = 0.998P0. 000), and there was no significant difference between the two mean values. There was a significant positive correlation between the volume of the liver and the volume of the liver of the specimen measured by the method of two times of pseudo-resection (r = 10.966P: 0.000: r = 0.971p ~ (0.000)). 3. It takes about 40-50 minutes to reconstruct liver, blood vessel and tumor images, and 20-30 minutes for each patient with further virtual hepatectomy. Conclusion the anatomical information of the individual liver and its vascular structure can be obtained by using the WIQQA-liver in the pre-hepatectomy planning. The virtual hepatectomy can accurately predict the liver volume and the residual liver volume. The application of this software will be completed. It plays an important role in accurate preoperative evaluation and safety during operation.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R657.3;R816.5

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