本文選題：三維重建 + 解剖��； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過CT三維重建腎臟集合系統(tǒng)的解剖分析集合系統(tǒng)的分型，以及集合系統(tǒng)在體表的投影位置，為經(jīng)皮腎鏡碎石術(shù)的非實時同步定位進(jìn)行目標(biāo)盞穿刺提供指導(dǎo)，簡化術(shù)中定位操作、避免醫(yī)患X-ray等過多的放射性損害，達(dá)到縮短PCNL的學(xué)習(xí)曲線。 方法：于2012年9月至2013年7月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院西院行GE公司Lightspeed多層螺旋CT機(jī)增強(qiáng)掃描并進(jìn)行三維重建的患者，，總數(shù)為50例腎臟數(shù)據(jù)，其中分別男23例腎臟，女27例腎臟，左側(cè)25例腎臟，右側(cè)25例腎臟，健康腎臟15例，積水患病腎臟13例，非積水患病腎臟22例。 1、采用德國的GE公司出的Volume viewer三維重建軟件工作站，并首先通過增強(qiáng)并三維重建的掃描圖像結(jié)果使用立體容積再現(xiàn)(V R)、3D影像的最大密度投影(3D-MIP)、影像的多平面再重建(MPR)、圖像立體曲面重建(CPR)等圖像三維重建技術(shù)最后形成的腎集合系統(tǒng)內(nèi)部解剖結(jié)構(gòu)的三維圖像。 2、仔細(xì)觀察腎臟集合系統(tǒng)的三維重建圖像，通過旋轉(zhuǎn)測量角度、放大局部結(jié)構(gòu)、多次剪裁、旋轉(zhuǎn)觀察等圖像處理。分析腎臟空間解剖特征，并對腎臟空間各個傾斜度、腎盂與腎盞及腎各大盞之間夾角、腎盞寬度和長度，計數(shù)腎小盞數(shù)量等數(shù)據(jù)測量、記錄。 3、上述數(shù)據(jù)均是采用SPSS19.0軟件、 Microsoft Excel軟件對所測量數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析。 結(jié)果：CT三維重建腎臟集合系統(tǒng)的解剖圖像顯示：1.腎臟中盞距離腎盂的路徑最短（即中盞的盞長徑最短），可向外輻射上、下盞相對面積大，腎中盞后組長軸幾乎垂直腎臟的長軸，且到達(dá)體表的距離較上、下盞長度短。2.右側(cè)腎臟大多數(shù)為成熟型（52.2%），左側(cè)腎臟大多數(shù)為分支型（50%）。正常腎臟集合系統(tǒng)分型大多數(shù)為不確定型（其中左側(cè)腎臟為60%，右側(cè)腎臟為60.9%），左側(cè)腎臟HODSON型較多，占左腎總數(shù)32%，右側(cè)腎臟BRODEL型較多，占右腎總數(shù)26%。3．患腎積水的集合系統(tǒng)形態(tài)學(xué)改變，一般分兩種類型分別是融合型與調(diào)色板型。4.約93%左側(cè)腎臟的集合系統(tǒng)上端邊緣在第11胸椎下緣水平，下部邊緣第3腰椎下緣以上，右側(cè)腎臟集合系統(tǒng)上端邊緣稍低，位于第12胸椎上緣以上，下端平第3腰椎上緣；約63%腎臟的腎盂在體表皮膚的投影在第1腰椎與第2腰椎得橫突區(qū)域；72%以上腎臟的中盞后組投影位于第11肋間隙末端向內(nèi)約1.5-2.5cm范圍內(nèi)。 結(jié)論：1、CT三維重建后的圖像顯示腎中盞后組有距體表較近、腎臟橫斷面的輻射面積廣、進(jìn)入上下盞清石容易等優(yōu)點(diǎn)使其可作為經(jīng)皮腎鏡取石術(shù)的最佳目標(biāo)盞，達(dá)到單通道清石率最高，且損傷最小。 2、術(shù)前CT三維重建腎臟集合系統(tǒng)解剖可以做到非實時同步定位進(jìn)行穿刺建立通道，減少對使用C臂等繁瑣操作的依賴性，減少X-ray對人體不必要的損害，對縮短PCNL的學(xué)習(xí)曲線有一定的幫助。
[Abstract]:Objective: to analyze the classification of the collection system and the projection position of the collection system in order to provide guidance for the non-real-time simultaneous localization of the target calyceal puncture in percutaneous nephrolithotripsy (percutaneous nephrolithotripsy). In order to shorten the learning curve of PCNL, the localization operation was simplified to avoid excessive radiation damage such as X-ray. Methods: from September 2012 to July 2013, a total of 50 patients (23 male, 23 male) underwent GE company Lightspeed multi-slice spiral CT enhanced scanning and 3D reconstruction in the Western Hospital of the first affiliated Hospital of Guangxi Medical University. There were 27 cases of female kidney, 25 cases of left kidney, 25 cases of right kidney, 15 cases of healthy kidney, 13 cases of hydronephrosis and 22 cases of non-hydronephrosis. 1. The 3D reconstruction software workstation of Volume viewer, which is produced by GE Company of Germany, is adopted. First of all, the 3D reconstruction technology was used to reconstruct the final shape of the 3D images by using 3D volume reconstruction, the maximum density projection 3D-MIP, the multi-plane reconstruction MPRP, the 3D curved surface reconstruction of the image CPR, and so on, through the results of the enhanced and 3D reconstruction of the scanning images by using the three-dimensional volume reconstruction technique, such as the maximum density projection of the 3D image and the multi-plane reconstruction of the image. A three-dimensional image of the anatomical structure of the renal ensemble system. (2) the 3D reconstruction images of the renal collection system are carefully observed, and the image processing is carried out by measuring the angle of rotation, enlarging the local structure, cutting many times, rotating observation and so on. The spatial anatomical characteristics of the kidney were analyzed, and the data of each inclination of renal space, the angle between renal pelvis and calyces, the width and length of renal calyces, and the number of calices were measured and recorded. 3. The above data were analyzed statistically by SPSS19.0 software and Microsoft Excel software. Results the anatomical image of the three-dimensional reconstruction of the renal collection system showed the image of 1: 1. The path from the middle calyx to the renal pelvis is the shortest (that is, the calyceal length of the middle calyceal, the shortest diameter, the relative area of the lower calyceal is large, the length of the lower calyx is shorter than that of the body surface, and the length of the lower calyx is shorter. Most of the right kidneys were mature and the left kidneys were mostly branched. Most of the normal renal aggregate system types were uncertain (60 in the left kidney, 60 in the right kidney, 60 in the left kidney, 32 in the total number of the left kidney, and 26. 3 in the right kidney). The morphological changes of collecting system of hydronephrosis were divided into two types: fusion type and palette type. 4. About 93% of the upper edge of the collecting system of the left kidney was at the level of the lower edge of the 11th thoracic vertebra, the lower edge of the third lumbar vertebra was above the lower edge of the third lumbar vertebra, and the upper edge of the right renal collecting system was slightly lower, which was located above the upper edge of the 12th thoracic vertebra and flattened at the lower end of the third lumbar vertebra. About 63% of the renal pelvis on the surface of the skin projected in the first lumbar vertebrae and the second lumbar vertebrae transverse process area more than 72% of the kidney in the middle calyceal group projection is located in the 11th intercostal space end inward about 1.5-2.5cm. Conclusion the three-dimensional reconstruction images of the middle calyceal group have the advantages of close to the body surface, wide cross-sectional radiation area, easy access to the upper and lower calyceal stones, and can be used as the best target for percutaneous nephrolithotomy. The stone removal rate of single channel is the highest, and the damage is minimum. 2. Three-dimensional CT reconstruction of renal collecting system anatomy before operation can achieve non-real-time simultaneous positioning for puncture to establish channels, reduce the dependence on the use of C-arm and other tedious operations, and reduce the unnecessary damage to human body caused by X-ray. It is helpful to shorten the learning curve of PCNL.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.2

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