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  本文關(guān)鍵詞： 肝切除 計算機(jī)輔助手術(shù) 肝體積測量 虛擬肝切除　出處：《南京大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討三維虛擬肝切除在臨床肝切除術(shù)前規(guī)劃中的應(yīng)用價值。 方法：搜集20例擬行肝切除患者的肝臟CT二維(2D)掃描數(shù)據(jù),導(dǎo)入IQQA-liver肝臟三維手術(shù)模擬軟件中進(jìn)行肝腫瘤、肝實質(zhì)、肝血管三維重建,生成個體化肝臟三維模型。由一名放射科醫(yī)生分別在兩名有經(jīng)驗的肝臟外科醫(yī)生指導(dǎo)下行虛擬肝切除,并測量全肝體積、擬切除肝體積、殘肝體積,以此指導(dǎo)肝切除手術(shù)規(guī)劃的制定,并將模擬手術(shù)過程與真實的手術(shù)過程進(jìn)行對比分析。將兩次測量的擬切除肝體積進(jìn)行相關(guān)性分析及均數(shù)比較。兩次測量的擬切除肝體積分別與術(shù)中排水法測量的實際標(biāo)本體積進(jìn)行相關(guān)性分析。 結(jié)果： 1.20例病人均成功進(jìn)行了肝臟、腫瘤和肝內(nèi)血管的三維分割、虛擬肝切除及手術(shù)規(guī)劃。虛擬肝切除評估所有病灶均可被根治性切除,術(shù)前規(guī)劃虛擬的圖像與術(shù)中實際所見匹配良好。該軟件還可進(jìn)行基于門靜脈灌注區(qū)及肝靜脈引流區(qū)的定量評估,有利于術(shù)前預(yù)測肝缺血、淤血范圍,并可提供靜脈重建的一個定量標(biāo)準(zhǔn)。 2.兩次測量擬切除肝體積之間顯示呈顯著正相關(guān)(相關(guān)系數(shù)r=0.998,P=0.000),并且兩者均值差異無統(tǒng)計學(xué)意義(t=0.197,P=0.846)。兩次擬切除肝體積和實際排水法測得標(biāo)本肝體積呈顯著正相關(guān)(相關(guān)系數(shù)r1=0.966,P：0.000；r2=0.971,P=0.000)。 3.該軟件重建肝臟、血管、腫瘤的融合圖像耗時約40-50分鐘左右,進(jìn)一步的虛擬肝切除每例病人耗時約20-30分鐘左右。 結(jié)論：IQQA-liver應(yīng)用于肝切除術(shù)前規(guī)劃可獲得個體化的肝臟及其血管結(jié)構(gòu)的解剖學(xué)信息。虛擬肝切除可較為準(zhǔn)確的預(yù)測擬切除肝體積和殘肝體積。此軟件的應(yīng)用將對完善術(shù)前精確評估及保障術(shù)中手術(shù)安全起到重要作用。
[Abstract]:Objective: to explore the application value of three-dimensional virtual hepatectomy in the planning of clinical hepatectomy. Methods: the CT 2D scan data of 20 patients with hepatectomy were collected, and the three-dimensional reconstruction of liver tumor, hepatic parenchyma and hepatic vessels were performed by IQQA-liver liver surgery simulation software. A three-dimensional model of the individual liver was created. A radiologist conducted a virtual hepatectomy under the guidance of two experienced liver surgeons, and measured the total liver volume, the intended liver volume, the residual liver volume. To guide the planning of hepatectomy, The simulated operation process and the real operation process were compared and analyzed. The correlation analysis and the mean value of the liver volume measured twice were compared with those measured by the drainage method. The correlativity of actual specimen volume was analyzed. Results:. 1.Twenty patients were successfully divided into three dimensions of liver, tumor and intrahepatic vessels, virtual hepatectomy and surgical planning. All lesions were evaluated by virtual hepatectomy for radical resection. The virtual images of preoperative planning match well with the actual results during operation. The software can also be used for quantitative evaluation based on portal vein perfusion area and hepatic venous drainage area, which is helpful to predict the extent of hepatic ischemia and congestion before operation. It can also provide a quantitative standard for venous reconstruction. 2. There was a significant positive correlation between the volume of the liver to be resected twice (r = 0.998P0. 000), and there was no significant difference between the two mean values. There was a significant positive correlation between the volume of the liver and the volume of the liver of the specimen measured by the method of two times of pseudo-resection (r = 10.966P: 0.000: r = 0.971p ~ (0.000)). 3. It takes about 40-50 minutes to reconstruct liver, blood vessel and tumor images, and 20-30 minutes for each patient with further virtual hepatectomy. Conclusion the anatomical information of the individual liver and its vascular structure can be obtained by using the WIQQA-liver in the pre-hepatectomy planning. The virtual hepatectomy can accurately predict the liver volume and the residual liver volume. The application of this software will be completed. It plays an important role in accurate preoperative evaluation and safety during operation.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R657.3;R816.5

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本文編號：1534773