中国实用外科杂志

中国实用外科杂志

• 普通外科进展 • 上一篇    下一篇

三维可视化技术在肝胆外科临床应用的争议与共识

范应方，方驰华   

  1. 南方医科大学珠江医院肝胆一科，广东 广州 510282
  • 出版日期:2018-02-01 发布日期:2018-02-24

  • Online:2018-02-01 Published:2018-02-24

摘要：

三维可视化技术已经成为肝胆外科疾病的术前诊断及评估、手术规划制定，术中指导、术后评估的重要工具，极大推动了肝胆外科疾病的精准诊疗水平。与CT和MRI自带图像后处理技术比较，三维可视化技术在图像三维重建和图像显示的方法步骤等方面均存在不同。CT和MRI的图像后处理软件采用多层面重组（MPR）、曲面重组（CPR）、容积再现技术（VRT）、多层面容积重组（MPVR）、表面阴影显示（SSD）、仿真内镜（VE）等技术对原始二维图像进行重组和二维显示，不涉及原始数据的预处理，图像显示技术为二维显像。而三维可视化技术经过对原始DICOM数据的预处理、图像分割、面绘制和体绘制重建等技术对原始二维图像进行三维重建，图像显示技术为三维可视化。两者均是对原始二维图像的二次处理和显示，存在一定程度的图像失真。三维可视化技术在肝胆外科疾病的定性诊断方面虽无优势，但在定位诊断、术前手术方案制定、提高手术成功率和预后等方面优于CT和MRI自带的图像后处理技术。外科医生应该根据疾病诊疗的临床需求选择合适的三维可视化软件。三维可视化技术开创了三维影像技术诊疗疾病的新模式，将成为精准外科不可或缺的重要组成部分。

关键词: 三维重建, 可视化, 肝胆外科

Abstract:

Controversy and consensus on the clinical application of three-dimensional visualization technology in hepatobiliary surgery        FAN Ying-fang, FANG Chi-hua.  First Department of Hepatobiliary Surgery, Zhujiang Hospital of Southern Medical University, Guangdong 510282,China
Corresponding author: FANG Chi-hua,E-mail:fangch_dr@126.com
Abstract    Three dimensional visualization technology has become an important technology for preoperative diagnosis and assessment, operative planning, intraoperative guidance and postoperative evaluation, which has greatly promoted the precise diagnosis and treatment level of hepatobiliary surgery diseases. There are differences between three dimensional visualization technology and post-processing technology of CT and MRI in both image reconstruction and image display. Using the three dimensional reformation technology, the post-processing software of CT and MRI recombines the original two dimensional images into three dimensional images without the preprocessing of the original data. These reformation technologies including multiplanar reformation (MPR), curved planar reformation (CPR), vloume rendering technique (VRT ) or volume reformation（VR）, multiplanar volume reconstruction(MPVR), surface shade display(SSD),and virtual endoscopy(VE). On the other hand, using the technologies including image pre processing, image segmentation, surface rendering or volume rendering, three dimensional visualization technology reconstructs the original two dimensional images (CT or MRI) into three dimensional images and displays these images by visualization technology. Due to the image distortion generated from the further dealing of original two-dimensional image both in three dimensional visualization technology and in post-processing software of CT or MRI, three dimensional visualization technology has no advantages in qualitative diagnosis,however,it is better than post-processing software of CT and MRI in terms of location diagnosis,preoperative planning, improving the the success rate and prognosis of surgery.Surgeons should choose the appropriate three dimensional visualization software on the basis of clinical needs. Three dimensional visualization technology is a new model for the diagnosis and treatment of dieases, which will become an indispensable part of precision surgery in the future.

Key words: three dimensional reconstruction, visualization, hepatobiliary surgery