iPlan CMF软件辅助下增强CT三维重建在头颈部肿瘤治疗中的应用

发布时间：2018-05-31 04:10

本文选题：头颈部肿瘤 + 动态增强计算机断层扫描　；参考：《北京大学学报(医学版)》2017年05期

【摘要】：目的:应用iPlan CMF软件重建头颈部肿瘤患者增强CT影像中的肿物及周围重要解剖结构,探讨iPlan CMF指导下增强CT三维重建技术在头颈部肿瘤手术治疗中的临床意义。方法:选取2014年6月至2015年6月就诊于北京大学口腔医学院口腔颌面外科的13例头颈部肿瘤紧邻重要神经、血管的患者,利用Seimens 16排螺旋CT薄层扫描技术,以额定扫描参数完成头颈部增强扫描,iPlan CMF软件直接读入Dicom格式原始数据,利用表面阴影重建法分别重建肿瘤、血管、骨骼及其他重要解剖结构,显示其术前三维空间关系,测量标记肿瘤与重要血管等解剖结构的距离,视肿瘤观察需要可行虚拟截骨,完成肿瘤暴露,设计手术入路,用以指导术前准备及手术。收集13例患者的术前准备、术中情况及术后并发症情况。结果:13例患者中,男6例,女7例,年龄23~65岁,中位年龄50岁。观察三维重建图像,可以清晰显示肿瘤范围、大小、位置及其与周围临近重要解剖结构的关系,根据三维重建图像,评估13例患者的手术风险,3例患者经过肿瘤三维重建等术前评估,建议综合治疗;10例患者完成术前准备并成功完成手术,其中3例患者术前备血及术中输血,2例患者邀请神经外科、胸外科协助手术,10例患者手术平均用时(202±135)min,手术平均出血(235±252)m L,三维标记与术中情况符合率为100%,其中1例患者由于肿瘤来源于迷走神经,术后出现声音嘶哑,其余患者未出现手术并发症。结论:利用iPlan CMF软件三维重建增强CT可以清楚显示头颈部深大肿瘤的特征及其与周围重要解剖结构的关系,有利于手术方案的设计,避免术中损伤重要解剖结构,减少术后并发症的产生。
[Abstract]:Objective: to study the clinical significance of three-dimensional enhanced CT reconstruction under the guidance of iPlan CMF in the surgical treatment of head and neck tumors. Methods: from June 2014 to June 2015, 13 patients with head and neck tumors adjacent to important nerves and blood vessels were selected from oral and maxillofacial surgery, School of Stomatology, Peking University. Seimens 16-slice spiral CT thin slice scanning technique was used. The original data of Dicom format were directly read into the CMF software of head and neck enhanced scanning with rated scanning parameters. The surface shadow reconstruction method was used to reconstruct tumor, blood vessel, bone and other important anatomical structures, respectively, and to show the three dimensional spatial relationship before operation. By measuring the distance between the tumor and the anatomic structure such as important blood vessels, virtual osteotomy was necessary for tumor observation, tumor exposure was completed, and an operative approach was designed to guide preoperative preparation and operation. The preoperative preparation, intraoperative condition and postoperative complications were collected in 13 patients. Results among the 13 patients, 6 were male and 7 female, aged 2365 years, with a median age of 50 years. The range, size, location of the tumor and its relationship with the adjacent important anatomical structures can be clearly displayed by observing the three-dimensional reconstruction images, according to the three-dimensional reconstruction images. To evaluate the surgical risk of 13 patients, 3 patients underwent three dimensional reconstruction of tumor before operation, and 10 patients were recommended for comprehensive treatment to complete preoperative preparation and successful operation. Among them, 3 patients had blood preparation before operation and 2 patients had invited neurosurgery during operation. The mean time of operation was 202 卤135 min and the mean bleeding was 235 卤252 min. The coincidence rate between 3D labeling and intraoperative conditions was 100. One patient developed hoarseness after operation because the tumor originated from vagus nerve. There were no surgical complications in the other patients. Conclusion: Three-dimensional reconstruction enhanced CT with iPlan CMF software can clearly display the features of deep large head and neck tumors and their relationship with the important anatomical structures around them, which is beneficial to the design of surgical schemes and to avoid the injury of important anatomical structures during operation. Reduce postoperative complications.
【作者单位】：北京大学口腔医学院·口腔医院口腔颌面外科口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室;
【基金】：国家科技支撑计划(2014BAI04B06) 北京市科委首都市民健康培育项目(Z161100000116053)资助~~
【分类号】：R739.91

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