中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (01): 40-43.

• 论著 • 上一篇    下一篇

腹部医学图像三维可视化系统辅助肝胆管结石诊治决策的价值

方驰华，陈智翔 ，范应方，苏仲和 ，李克晓 ，项 楠 ，杨 剑   

  1. 南方医科大学珠江医院肝胆外科，广东广州510282
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2010-01-12 发布日期:2010-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2010-01-12 Published:2010-01-12

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摘要：

目的 研究腹部医学图像三维可视化系统在辅助肝胆管结石诊治决策中的价值。方法 选取南方医科大学珠江医院2007-2009年收治的22例肝胆管结石病人的肝脏64排CT扫描数据，将数据导入腹部医学图像三维可视化系统进行程序分割、三维重建。根据三维模型制定诊治策略，利用自主研发的虚拟手术器械仿真系统进行仿真手术并指导临床手术。结果 22例病人中，I型4例，Ⅱ型2例，E型16例。多次胆道手术6例；局部胆管狭窄16例；伴肝硬化5例；伴萎缩-肥大综合征16例。三维模型清晰显示结石的大小、数量、形态、空间位置；胆管狭窄的位置、程度、长度。对照此后进行的手术，重建模型与术中所见均符合，手术方式符合者19例（不符合3例均为急诊入院）；非急诊手术病人术后行直接胆道造影显示无结石残留。结论 腹部医学图像三维可视化系统能更快速准确地诊断肝胆管结石，有助于治疗策略的选择，指导个体化手术方式。

关键词: 肝胆管结石, 三维, 医学图像/腹部, 可视化

Abstract:

Value of abdominal three-dimensional medical image visible system in diagnosis and treatment of hepatolithiasis FANG Chi-hua,CHEN Zhi-xiang,FANG Ying-fang,et al. Department of Hepatobiliary Surgery,Zhujiang Hospital ,Southern Medical University,Guangzhou510282,China Corresponding author:FANG Chi-hua,E-mail: fangch_dr@126.com Objective To study the value of abdominal three-dimensional medical image visible system in diagnosis and treatment of hepatolithiasis. Methods 22 patients’ 64-slice spiral computer tomography (CT) scan data which admitted to Zhujiang Hospital from 2007 to 2009 were chosen. The data was imported into abdominal three-dimensional medical image visible system for sequence segmenting and three-dimensional (3D) reconstruction. According to the models, patients were diagnosed and the pre-operation plannings were made. The reconstructed models were used to perform simulation surgery with virtual surgical instruments simulation system. At last, clinical surgerys were guided by simulation surgery. Result within the 22 patients, 4 were type I, 2 were type Ⅱ, and 16 were type E. Including 6 patients with surgeries on biliary tract for several times; 16 cases with bile duct striture; 5 cases with cirrhosis; 16 cases with atrophy-mast syndrome. The 3D models showed the size, the amount and the location of the stone clearly, as well as the lacation, the degree and the lenth of the sticture. The clinical surgeries wre consistent with the simulation sugeries by 19/22(the other three wre emergency). T-tube angiography of the non-emergency patients showed that there were no stones residue. Conclusions The abdominal three-dimensional medical image visible system can make a rapid dignosis of hepatolithiasis, which was helpful for planning for the individual treatment.

Key words: hepatolithus, three-dimension, medical image/abdominal, visualization