本文選題：三維重建 + 腹主動(dòng)脈��； 參考：《婦產(chǎn)與遺傳(電子版)》2016年04期

【摘要】：目的應(yīng)用數(shù)字化三維重建技術(shù)構(gòu)建腹部大血管三維模型并對模型進(jìn)行解剖學(xué)測量,從而探討其在腹主動(dòng)脈旁淋巴結(jié)切除術(shù)中的指導(dǎo)價(jià)值。方法選取2012年9月~2014年5月在南方醫(yī)科大學(xué)南方醫(yī)院行腹盆腔CT血管成像檢查(Computed tomo-angiography,CTA)的患者251例,構(gòu)建腹盆腔大血管數(shù)字化三維模型,利用mimics軟件坐標(biāo)定位法分別測量并記錄在腎動(dòng)脈水平、腸系膜下動(dòng)脈水平腹主動(dòng)脈右側(cè)壁與下腔靜脈左側(cè)壁之間的水平距離,以及腹主動(dòng)脈分叉點(diǎn)與左右髂總靜脈匯合點(diǎn)間的上下距離,并以10 mm間距為一類進(jìn)行分類統(tǒng)計(jì)。結(jié)果應(yīng)用數(shù)字化三維重建技術(shù)成功構(gòu)建腹主動(dòng)脈與下腔靜脈模型,其中有兩例數(shù)據(jù)存在變異,一例為左下腔靜脈、一例為雙下腔靜脈,其他249例數(shù)據(jù)腹主動(dòng)脈和下腔靜脈未見明顯變異。按照三個(gè)水平進(jìn)行測量,下腔靜脈和腹主動(dòng)脈的最小水平間距為0,在腎動(dòng)脈水平(n=177),腹主動(dòng)脈與下腔靜脈間距離(a)最大為62.8 mm,最多見類型為間距1~2 cm組,占53.10%;在腸系膜下動(dòng)脈水平(n=238),二者最大間距為33.81 mm,最多見類型為0~1 cm組,占59.20%;而在髂總動(dòng)脈分叉點(diǎn)水平(n=238),二者間最大距離是49.74 mm,最多見類型為2~3 cm組,占47.40%;結(jié)論采用數(shù)字化三維重建技術(shù)可成功構(gòu)建在體腹部大血管三維模型,并依此進(jìn)行三維解剖測量。腹主動(dòng)脈與下腔靜脈的變異情況并不多見,二者之間的間距在不同水平大小不一,腎動(dòng)脈水平1~2 cm為主,腸系膜下動(dòng)脈水平0~1 cm為主,而髂總動(dòng)脈分叉水平以2~3 cm為主,既有規(guī)律性又有特異性,術(shù)前三維模型可以協(xié)助了解二者的精確位置,增加術(shù)者術(shù)中對腹主動(dòng)脈與下腔靜脈空間關(guān)系的辨識度,并快速定位,從而減少醫(yī)源性血管、臟器的損傷,增加腹主動(dòng)脈旁淋巴結(jié)切除手術(shù)的安全性,也為今后大體解剖學(xué)測量提供新思路。
[Abstract]:Objective to construct a three-dimensional model of abdominal macrovascular by digital three-dimensional reconstruction and to measure the anatomy of the model, and to explore the guiding value of the model in para-aortic lymphadenectomy. Methods from September 2012 to May 2014, 251 patients underwent computed tomo-angiographic angiography (CTAA) in Southern Hospital of Southern Medical University. The horizontal distances between the right wall of the abdominal aorta and the left wall of the inferior vena cava were measured and recorded by mimics software coordinate positioning method at the level of renal artery, the level of inferior mesenteric artery, and the left wall of inferior vena cava. The upper and lower distance between the bifurcation point of abdominal aorta and the confluence point of left and right common iliac veins was classified and counted according to the distance of 10 mm. Results the models of abdominal aorta and inferior vena cava were successfully constructed by using digital 3D reconstruction technique. Two of them had data variation, one was left inferior vena cava and the other was double inferior vena cava. There was no significant variation in other 249 cases of abdominal aorta and inferior vena cava. The minimum horizontal distance between the inferior vena cava and the abdominal aorta was 0, the maximum distance between the abdominal aorta and the inferior vena cava was 62.8 mm at the renal artery level and the distance between the abdominal aorta and the inferior vena cava was 62.8 mm. At the level of inferior mesenteric artery, the maximum distance between them was 33.81 mm, the most common type was 0 ~ 1 cm group (59.20%), but at the level of common iliac artery bifurcation point, the maximum distance between them was 49.74 mm and the most common type was 23 cm group. Conclusion Three-dimensional reconstruction technique can be used to construct a three-dimensional model of the great vessels in the abdomen, and the three-dimensional anatomical measurement can be carried out according to it. The variation of abdominal aorta and inferior vena cava was rare. The distance between them was different at different levels. The renal artery level was 1 ~ 2 cm, the inferior mesenteric artery level was 0 ~ 1 cm, and the common iliac artery bifurcation level was 2 ~ 3 cm. The three-dimensional model before operation can help to understand the exact location of the two, increase the recognition of the spatial relationship between abdominal aorta and inferior vena cava during operation, and locate them quickly, thus reducing the iatrogenic blood vessels. The injury of viscera increases the safety of para-aortic lymphadenectomy, and provides a new idea for the measurement of gross anatomy in the future.
【作者單位】： 陜西省婦幼保健院婦科;南方醫(yī)科大學(xué)南方醫(yī)院婦產(chǎn)科;南方醫(yī)科大學(xué)南方醫(yī)院影像中心;
【基金】：科技部十二五國家科技支撐項(xiàng)目(863預(yù)備項(xiàng)目:2014BAI05B03) 廣州市科技計(jì)劃健康醫(yī)療協(xié)同創(chuàng)新重大專項(xiàng)(201508020264) 國家自然科學(xué)基金(81370736,81571422)
【分類號】：R654.3

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