本文關鍵詞：肝臟靜脈三維重建及肝內(nèi)門體靜脈分流術穿刺入路可視化研究　出處：《第三軍醫(yī)大學》2007年博士論文　論文類型：學位論文

  更多相關文章： 肝內(nèi)靜脈管道 門體靜脈分流 斷面解剖 重采樣 三維重建 可視化

【摘要】： 肝臟是人體內(nèi)體積最大、具有重要生理功能的臟器。肝臟管道系統(tǒng)的肝靜脈系、門靜脈系及肝后段下腔靜脈的解剖結構交錯重疊、相互關系復雜,是肝內(nèi)血管介入治療和肝臟手術切除的難點。經(jīng)頸靜脈肝內(nèi)門體靜脈分流術(Transjugular Intrahepatic Portosystemic Shunt, TIPS)是近年來發(fā)展起來的一項專門治療門靜脈高壓癥的介入放射學新技術,它采用多項介入技術,在門靜脈和腔靜脈之間通過介入器械搭建一個有效的靜脈分流通道,使部分門靜脈血流直接匯入下腔靜脈而回流入心,治療由于肝硬化等疾病所引起的門靜脈高壓。該技術操作的關鍵是準確掌握肝臟靜脈管道間解剖結構的空間關系,設計適合導管介入治療的路徑,選擇正確的穿刺點和適宜的分流通道,建立穩(wěn)定而持久的肝內(nèi)靜脈分流途徑,避免在手術操作中損傷毗鄰的重要結構。 本實驗應用數(shù)字化可視人體數(shù)據(jù)集,選擇自頸內(nèi)靜脈平面至肝臟下緣平面的連續(xù)薄層橫斷面圖像序列,經(jīng)精確配準后進行計算機圖像重采樣處理獲取TIPS術路徑的橫斷面、冠狀斷面和矢狀斷面三個方位的連續(xù)薄層斷面圖像數(shù)據(jù)集,并對各方位斷面圖像進行斷層解剖學結構觀察和數(shù)據(jù)測量;運用圖像分割軟件,采取對連續(xù)斷面解剖結構追蹤顯示的方法,分別對數(shù)據(jù)集中的頸內(nèi)靜脈、頭臂靜脈、上腔靜脈、心臟、下腔靜脈、肝靜脈和門靜脈結構進行數(shù)據(jù)分割和邊界提取,并在計算機上進行TIPS術路徑及其改良術式-直接性門腔靜脈分流術(Direct Intrahepatic Portacaval Shunt, DIPS)路徑的三維重建,構建肝內(nèi)門體分流三維模型,并觀測和比較TIPS術與DIPS術路徑的空間結構關系、穿刺路線和內(nèi)支架位置;利用可視化軟件,采用交互手動分割和自動閾值分割相結合的數(shù)據(jù)提取法進行圖像分割,在圖形工作站上完成經(jīng)頸靜脈肝內(nèi)門體靜脈分流術路徑的三角形網(wǎng)格表面重構,構建肝內(nèi)門體靜脈分流的三維可視化模型,實現(xiàn)在可視化平臺基礎上進行立體觀察和三維測量;應用虛擬內(nèi)窺鏡(Virtual Endoscopy, VE)技術,在肝內(nèi)門體分流三維重建模型和可視化平臺的基礎上,進行經(jīng)頸靜脈至肝內(nèi)門靜脈管道內(nèi)介入導管的虛擬內(nèi)窺鏡的漫游和觀察,模擬介入穿刺針進行經(jīng)肝靜脈至肝內(nèi)門靜脈的門體靜脈分流和經(jīng)肝后段下腔靜脈至肝內(nèi)門靜脈的門體靜脈分流的虛擬穿刺。主要研究結果如下: 1.應用數(shù)字化可視人體數(shù)據(jù)集,選擇自頸內(nèi)靜脈平面至肝臟下緣平面連續(xù)薄層橫斷面圖像序列,經(jīng)精確配準后完成計算機圖像重采樣,獲取經(jīng)頸靜脈肝內(nèi)門體靜脈分流術路徑的橫斷面、冠狀斷面和矢狀斷面三個方位的連續(xù)薄層斷面的圖像數(shù)據(jù)集,實現(xiàn)了對同一例標本進行多方位的斷面圖像信息獲取。 2.在圖像數(shù)據(jù)集上完成了對斷層圖像橫斷面、冠狀斷面和矢狀斷面多方位斷層解剖結構的觀察及比較,斷面圖像結構完整、圖像清晰,闡明了各方位肝內(nèi)靜脈管道的形態(tài)學特點,并獲取斷面圖像二維測量資料,為肝內(nèi)門體靜脈分流術提供斷面解剖學形態(tài)依據(jù)。 3.運用圖像分割軟件,采取對連續(xù)斷面解剖結構追蹤顯示模式,對經(jīng)頸靜脈肝內(nèi)門體靜脈分流術路徑的主要結構進行了數(shù)據(jù)分割和邊界提取,在計算機上構建了肝內(nèi)門體靜脈分流術路徑的三維重建模型,觀測并比較了TIPS術和DIPS術穿刺入路重建結構的空間關系,獲取了穿刺路線和虛擬內(nèi)支架三維數(shù)據(jù),為肝內(nèi)門體靜脈分流術的穿刺入路提供了立體形態(tài)學依據(jù)。 4.利用可視化軟件,采用手動交互分割和自動閾值分割相結合的圖像數(shù)據(jù)提取方式在圖形工作站上完成經(jīng)頸靜脈肝內(nèi)門體靜脈分流術路徑的表面重構,構建了肝內(nèi)門體靜脈分流的三維可視化模型,實現(xiàn)了在可視化平臺基礎上的立體觀察和三維測量,為肝內(nèi)門體靜脈分流術進一步深入研究提供了可視化平臺和三維結構數(shù)據(jù)。 5.應用虛擬內(nèi)窺鏡技術,在肝內(nèi)門體靜脈分流術路徑的三維可視化平臺上,完成了肝臟靜脈管道內(nèi)介入導管的虛擬內(nèi)窺鏡漫游和觀察,以內(nèi)窺鏡的視角清晰、生動地顯示并描述了TIPS術路徑和DIPS術路徑管道內(nèi)部結構特征。 6.在圖形工作站上,模擬了介入手術穿刺針進行經(jīng)肝靜脈至肝內(nèi)門靜脈的門體靜脈分流和經(jīng)肝后段下腔靜脈至肝內(nèi)門靜脈的門腔靜脈分流的虛擬穿刺,演示了靜脈穿刺入路的路徑和過程,為建立肝臟血管內(nèi)介入手術模擬訓練系統(tǒng)奠定了基礎。 7.依據(jù)肝內(nèi)靜脈管道特點,在三維可視化模型基礎上設計了肝內(nèi)門體靜脈的介入導管的穿行路徑和穿刺入路,比較了TIPS術和DIPS術路徑穿刺入路的特點,為肝內(nèi)門體靜脈分流術提供了術前規(guī)劃并制定合理的個性化介入手術方案的初步的計算機模型。
[Abstract]:Transthoracic Intrahepatic Portosystemic Shunt is a new technique for the interventional radiology of portal hypertension . Transthoracic Intrahepatic Portosystemic shunt ( transjugular intrahepatic portosystemic shunt ) is a new technique for the interventional therapy of portal hypertension . The three - dimensional visualization model of intrahepatic portacaval portacaval shunt ( DIPS ) is used to study and compare the three - dimensional reconstruction of portal vein , portal vein , superior vena cava , heart , inferior vena cava , hepatic vein and portal vein . 1 . The digital visual human data set is applied to select the continuous thin - layer cross section image sequence from the plane of the internal jugular vein to the lower edge of the liver , and after the accurate registration , the computer image is re - sampled , and the image data set of the cross section , the coronal section and the sagittal section of the jugular intrahepatic portal vein shunt path is acquired , and the multi - azimuth cross section image information acquisition is realized for the same specimen specimen . 2 . The cross section , coronal section and sagittal section multi - azimuth fault anatomical structure are observed and compared on the image data set . The section image structure is complete , the image is clear , the morphological characteristics of each azimuth hepatic vein duct are clarified , and the two - dimensional measurement data of the section image is acquired , which provides the basis for sectional anatomy for the hepatic portal vein shunt . 3 . Using image segmentation software , the main structure of portal vein shunt was divided and extracted . The three - dimensional reconstruction model of portal vein shunt was constructed on the computer . The spatial relationship between transjugular approach and DIPS was compared . The three - dimensional data of puncture route and virtual inner stent were obtained . 4 . Using the visualization software , the surface reconstruction of the portal vein shunt in the jugular intrahepatic portal vein is accomplished by using the image data extraction method combined with manual interaction segmentation and automatic threshold segmentation , and the three - dimensional visualization model of the hepatic portal vein shunt is constructed . The three - dimensional observation and the three - dimensional measurement on the visualization platform are realized , and the visualization platform and the three - dimensional structure data are further researched for further study of the hepatic portal vein shunt . 5 . Using virtual endoscopy technology , the virtual endoscopy and observation of the interventional catheter in the hepatic vein were completed on the three - dimensional visualization platform of the portal vein shunt pathway in the hepatic portal vein . 6 . On the graphic workstation , the virtual puncture of portal vein shunt and portal vein shunt through the portal vein in the hepatic vein to the intrahepatic portal vein were simulated . The path and procedure of vein puncture were demonstrated , which laid the foundation for the establishment of a simulated training system for hepatic vascular interventional procedure . 7 . On the basis of three - dimensional visualization model , the puncture path and the puncture approach of the interventional catheter of the hepatic portal vein were designed based on the characteristics of the hepatic vein , compared the characteristics of the transjugular approach and the DIPS path puncture approach , and provided a preliminary computer model for preoperative planning and the establishment of a reasonable personalized interventional procedure .

【學位授予單位】：第三軍醫(yī)大學
【學位級別】：博士
【學位授予年份】：2007
【分類號】：R322;R657.3

【引證文獻】

相關碩士學位論文 前1條

1 孫俊旗;磁共振肝臟三維模型及虛擬肝切除在肝臟外科計劃的應用[D];汕頭大學;2010年

，

本文編號：1439131