基于个体化三维仿真模型的手术规划导引技术在后腹腔镜肾上腺嗜铬细胞瘤切除术中的应用

发布时间：2018-03-28 05:30

本文选题：体层摄影术　切入点：X线计算机　出处：《中国医学影像技术》2015年04期

【摘要】：目的观察自主研发的个体化三维医学影像重建与导引系统(3D-MIRGS)在后腹腔镜下嗜铬细胞瘤切除术中的临床应用价值。方法将23例诊断为肾上腺嗜铬细胞瘤拟行后腹腔镜手术患者的腹部64层螺旋CT薄层增强扫描数据导入3D-MIRGS,进行计算机与人工矫正相结合、多时相数据相补充模式下的图像分割、重建及融合,在与传统CT后处理技术(VR)图像对比的基础上根据所获得的肾上腺及瘤体个体化数字模型观察肾上腺中央静脉的走行、毗邻等情况以及瘤体与周围器官的立体解剖关系,制定术前规划,并在术中完成精确实时定位导引。结果 23例患者均由3D-MIRGS成功构建个体化数字模型,与VR图像对比可同期一体化更清晰显示患侧肾上腺中央静脉及瘤体的形态与边界。个体化三维数字模型成功为23例患者在后腹腔镜嗜铬细胞瘤切除术中完成了辅助导引,有效减少了血管探查造成的瘤体激惹,进而避免了术中出现血压大幅波动及出血相关性并发症。结论 3D-MIRGS可在后腹腔镜下嗜铬细胞瘤切除术前对肾上腺中央静脉做出清晰直观的空间定位诊断,并完成个体化手术方案规划及术中导引,可有效增加嗜铬细胞瘤手术安全性及成功率,减少围手术期并发症的发生。
[Abstract]:Objective to observe the clinical value of individualized 3D medical image reconstruction and guidance system 3D-MIRGSin retroperitoneal laparoscopic excision of pheochromocytoma. Methods 23 cases of adrenal pheochromocytoma were diagnosed as adrenal pheochromocytoma. The abdominal 64-slice spiral CT thin-slice enhanced scanning data were imported into 3D-MIRGS. computer and artificial correction were performed. The image segmentation, reconstruction and fusion in the multitemporal data complementary mode were compared with the conventional CT post-processing technique (VRV). Based on the individual digital model of adrenal gland and tumor, the central adrenal vein was observed. Contiguous condition and stereoscopic anatomical relationship between the tumor and surrounding organs were established, preoperative planning was made, and accurate real-time positioning guidance was completed during the operation. Results the individual digital model was successfully constructed by 3D-MIRGS in 23 patients. Comparing with VR images, the central adrenal vein and the tumor's shape and boundary could be clearly displayed simultaneously. The individualized three-dimensional digital model was successfully used to guide 23 patients in retroperitoneal laparoscopic pheochromocytoma resection. It can effectively reduce tumor irritation caused by vascular exploration. Conclusion 3D-MIRGS can make clear and intuitionistic diagnosis of central adrenal vein before retroperitoneal laparoscopic excision of pheochromocytoma. Individualized operation planning and intraoperative guidance can effectively increase the safety and success rate of pheochromocytoma and reduce perioperative complications.
【作者单位】：山西医科大学第一医院泌尿外科;
【分类号】：R730.44;R736.6

【参考文献】