【摘要】：影像引導(dǎo)消融治療是治療實體腫瘤的有效方法。傳統(tǒng)的二維影像引導(dǎo)雖然獲得了顯著成果，但尚有諸多不足。三維影像導(dǎo)航的出現(xiàn)能夠推動影像引導(dǎo)消融治療達到新高度。因此，本論文提出了術(shù)中三維影像導(dǎo)航，并對三維影像導(dǎo)航的關(guān)鍵技術(shù)進行了基礎(chǔ)和臨床研究,成功的將三維影像導(dǎo)航技術(shù)應(yīng)用于臨床，并取得滿意的療效。 本論文主要工作如下： 1.超聲探頭標定的基礎(chǔ)研究。成功的建立了通過自制“N”型線框模板精準標定超聲探頭的方法，獲取探頭標定位移參數(shù)Tx、Ty、Tz和旋轉(zhuǎn)參數(shù)Rα、Rβ、Rγ；并通過自制剛體模型1號驗證了該標定方法具有較高的精準度，為在三維影像上實時顯示超聲探頭掃查切面即實時三維影像導(dǎo)航奠定了基礎(chǔ)。 2.三維導(dǎo)航技術(shù)的基礎(chǔ)研究。成功將微波消融針針尖標定至三維影像內(nèi)，，可實時顯示微波消融針虛擬圖像，并通過自制剛體模型2號驗證了三維導(dǎo)航平均誤差約0.52mm±0.389，應(yīng)用CIRS標準模擬腹部穿刺體模驗證了三維導(dǎo)航引導(dǎo)穿刺8～14mm模擬病灶準確性為91.43%，為三維影像導(dǎo)航技術(shù)的臨床應(yīng)用奠定基礎(chǔ)。 3.圖像配準融合的臨床研究。應(yīng)用配對設(shè)計的臨床實驗比較體內(nèi)定標法和體表定標法配準融合誤差。實驗對象為臨床患者的肝腫瘤病灶，融合圖像為超聲與CT。體表定標法配準融合平均誤差8.9mm±4.15，體內(nèi)定標法配準融合平均誤差7.58mm±3.88，P＜0.05；體表定標法配準融合平均時間195s±43.55，體內(nèi)定標法配準融合平均時間457.62s±290.81，P＜0.05。本研究為三維導(dǎo)航技術(shù)中的配準融合方法的選擇提供了依據(jù)。 4.三維影像導(dǎo)航引導(dǎo)消融治療的臨床研究。第一節(jié)，應(yīng)用三維影像導(dǎo)航技術(shù)引導(dǎo)消融治療常規(guī)超聲顯示不清或顯示不完全的原發(fā)性肝癌病灶，成功對13例患者15個結(jié)節(jié)進行了消融治療，療效滿意，一次治療成功率80%，局部進展率7.1%，三維影像導(dǎo)航技術(shù)用于治療常規(guī)超聲顯示不清或顯示不完全的原發(fā)性肝癌可行、安全、有效。第二節(jié)設(shè)計了前瞻性非隨機對照隊列研究，對比三維影像導(dǎo)航和傳統(tǒng)二維超聲引導(dǎo)微波消融原發(fā)性肝癌的空間布針效果，三維導(dǎo)航組一次治療成功率8.3%，二維超聲組37.%，P＜0.05；三維導(dǎo)航組平均布針時間300.5s±46.53，二維超聲組521.04s±143.91，P＜0.05；三維影像導(dǎo)航能夠提高肝腫瘤消融空間布針的有效性并縮短平均布針時間。 結(jié)論：三維影像導(dǎo)航技術(shù)精度高、立體空間信息豐富，用于引導(dǎo)微波消融治療肝癌可行、安全、有效，并且能夠提高肝癌消融空間布針的有效性，縮短平均布針時間。
[Abstract]:Image-guided ablation is an effective method for the treatment of solid tumors. Although the traditional two-dimensional image guidance has achieved remarkable results, there are still many shortcomings. The appearance of three-dimensional image navigation can promote the treatment of image-guided ablation to a new level. Therefore, in this paper, 3D image navigation is put forward, and the key technology of 3D image navigation is studied in the foundation and clinic. The 3D image navigation technology is successfully applied in clinic, and the curative effect is satisfactory. The main work of this paper is as follows: 1. The basic Research of Ultrasonic probe Calibration. The method of accurately calibrating ultrasonic probe by self-made "N" shape wire frame template is established successfully, and the calibration displacement parameters Tx,Ty,Tz and rotation parameters R 偽, R 尾, R 緯 of the probe are obtained. The accuracy of the calibration method is verified by self-made rigid body model No. 1, which lays a foundation for the real-time display of ultrasonic probe scanning and tangent plane on 3D image, that is, real-time 3D image navigation. 2. The basic research of three-dimensional navigation technology. The microwave ablation needle tip was successfully calibrated into 3D image, and the virtual image of microwave ablation needle could be displayed in real time. The mean error of three-dimensional navigation was verified by self-made rigid body model No. 2, which was about 0.52mm 鹵0.389. The accuracy of three-dimensional navigation guided puncture 8~14mm simulation was 91.43, which laid a foundation for the clinical application of three-dimensional image navigation technology. 3. Clinical study of image registration fusion. In-vivo calibration method and body surface calibration method were used to compare the registration and fusion errors. The experimental object was the focus of liver tumor in clinical patients, and the fusion images were ultrasound and CT.. The average error of body surface calibration was 8.9mm 鹵4.15, and that of in vivo calibration was 7.58mm 鹵3.88 (P < 0.05). The mean fusion time of body surface calibration method was 195s 鹵43.55, and that of body surface calibration method was 457.62s 鹵290.81g (P < 0.05). This study provides a basis for the selection of registration and fusion methods in three-dimensional navigation technology. 4. Clinical study of three-dimensional Image Navigation guided Ablation Therapy. In the first section, three dimensional image navigation technique was used to guide ablation in the treatment of primary liver cancer with conventional ultrasound. Thirteen patients with 15 nodules were successfully treated with ablation. The success rate of one treatment was 80%. The local progression rate is 7.1%. Three-dimensional imaging navigation technique is feasible, safe and effective in the treatment of primary liver cancer with conventional ultrasound. In the second section, a prospective non-randomized controlled cohort study was designed to compare the effects of three-dimensional image navigation and conventional two-dimensional ultrasound guided microwave ablation of primary liver cancer with spatial needle placement. The success rate of one treatment in the three-dimensional navigation group was 8.3%. In the two dimensional ultrasound group, the ratio of 37. 0% and 37%, P < 0. 05; The mean needling time of three-dimensional navigation group was 300.5s 鹵46.53, and that of two-dimensional ultrasound group was 521.04s 鹵143.91 (P < 0.05). Conclusion: the three-dimensional image navigation technology has high accuracy and rich three-dimensional spatial information. It is feasible, safe and effective to guide microwave ablation for the treatment of liver cancer. It can also improve the effectiveness of space needle placement and shorten the average needle placement time.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R735.7;R445.1

【共引文獻】

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本文編號：2332038