3D数字肺软件的研发及在低肺功能储备的多发肺内小结节患者术前规划中的运用

发布时间：2018-05-10 22:16

  本文选题：三维 + 定位　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨3D数字肺肺段自动划分/虚拟手术软件(简称3D数字肺软件)在低肺功能储备的多发肺小结节患者术前精准定位肺内小结节、预判肺结节术后肺功能变化和指导胸腔镜下同期多肺段切除术的运用经验和体会。方法:选取2014年12月至2017年2月中国人民解放军174医院既往有单侧肺单一肺叶/亚肺叶切除史或因慢性支气管炎、肺气肿等肺部疾病病史,肺功能处于肺手术临界值,一侧肺多发肺内结节的10个住院患者作为研究对象,。术前采用320排CT的超薄层扫描做肺动脉CTA,CT图像数据导入3D数字肺软件进行三维重建,并以肺动脉系统为基础进行肺段自动划分,对肺内动静脉、支气管及肺结节进行三维重建,并自动划出肺结节所属肺段。同时3D数字肺软件计算拟切除的病变肺段占全肺的体积比例,估算手术对第1秒肺活量(FEV1)的影响,评估患者对手术的耐受性。做好手术前规划后,根据术前规划的手术路径在全麻下行胸腔镜下同期多肺段/亚段切除术。结果:10个病例的肺动脉三维重建均能达到5级以下分支水平,并自动划分出肺段,清楚显示肺内结节所在肺段/亚段,清晰的显示段支气管、肺动脉及肺结节的关系,降低了因支气管或肺血管变异时导致副损伤的风险。10个病例预切除肺体积占全肺体积13%-27%。估算术后FEV1为1.16-1.65L,能耐受手术。10个病例均顺利施行全麻胸腔镜下多个肺段/亚段切除术,术中未出现临近支气管、肺动静脉等副损伤情况,切下肺段立即解剖找到肺内结节,并送快速病理检查明确诊断。术后患者恢复顺利,无呼吸功能不全表现,术后住院时间4-5天。结论:3D数字肺软件,不但可以自动划分肺段,精确定位肺内结节位置,显示目标肺段动静脉、支气管与周围动静脉、支气管的关系,有利于降低术中副损伤的风险;还能计算病变肺段的体积,估算手术对FEV1的影响,帮助术者准确的、量化的评估多发肺内结节患者对同期多肺段切除术的耐受性。从而更有利于患者的手术安全及术后的生活质量。
[Abstract]:Objective: to investigate the accuracy of preoperative localization of pulmonary nodules in patients with multiple pulmonary nodules with low pulmonary function reserve by 3D digital lung segment automatic division / virtual surgery software. Experience and experience in predicting pulmonary function after pulmonary nodule operation and guiding simultaneous multi-segmental resection under thoracoscope. Methods: from December 2014 to February 2017, 174 Hospital of the Chinese people's Liberation Army had a history of unilateral lung lobectomy / sublobectomy or a history of chronic bronchitis, emphysema and other pulmonary diseases, and the lung function was at the critical value of lung surgery. Ten inpatients with multiple pulmonary nodules in one lung were studied. The CT data of pulmonary artery were imported into 3D digital lung software to reconstruct the pulmonary artery with ultrathin slice scan of 320 slice CT before operation. The pulmonary segment was divided automatically based on pulmonary artery system, and the pulmonary artery and vein, bronchus and pulmonary nodule were reconstructed. The pulmonary nodules belong to the lung segment. At the same time, 3D digital lung software was used to calculate the volume ratio of the diseased lung segment to the whole lung, to estimate the effect of the operation on the first second vital capacity and FEV1), and to evaluate the patient's tolerance to the operation. After preoperation planning, multiple lung segmental / subsegmental resection was performed under general anesthesia according to the planned operation path before operation. Results: the three dimensional reconstruction of pulmonary artery in 10 cases could reach the level of subgrade 5 branches, and the pulmonary segments could be divided automatically. The pulmonary segments / subsegments of the pulmonary nodules were clearly displayed, and the relationship among segmental bronchi, pulmonary arteries and pulmonary nodules was clearly displayed. Reduced risk of collateral damage due to bronchi or pulmonary vascular abnormalities. 10 cases with preresectomized lung volume 13-27. The postoperative FEV1 was estimated to be 1.16-1.65L. all the 10 patients underwent thoracoscopic resection of multiple lung segments / subsections under general anesthesia without collateral injury such as adjacent bronchus, pulmonary arteriovenous injury, etc. The pulmonary nodules were dissected immediately after resection. The diagnosis was confirmed by rapid pathological examination. The patient recovered smoothly and had no respiratory insufficiency. The postoperative hospital stay was 4-5 days. Conclusion3D digital lung software can not only automatically divide the lung segment, accurately locate the location of pulmonary nodule, but also show the relationship between the target lung segment arteriovenous, bronchus and peripheral arteriovenous, bronchus, which is helpful to reduce the risk of collateral injury during operation. It can also calculate the volume of the diseased lung segment, estimate the effect of operation on FEV1, and help the operator to evaluate accurately and quantitatively the tolerance of patients with multiple pulmonary nodules to multiple segmental pneumonectomy at the same time. So it is more conducive to the patient's operation safety and postoperative quality of life.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：TP311.52;R734.2
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本文编号：1871151