本文選題：三維 + 定位��； 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討3D數字肺肺段自動劃分/虛擬手術軟件(簡稱3D數字肺軟件)在低肺功能儲備的多發(fā)肺小結節(jié)患者術前精準定位肺內小結節(jié)、預判肺結節(jié)術后肺功能變化和指導胸腔鏡下同期多肺段切除術的運用經驗和體會。方法:選取2014年12月至2017年2月中國人民解放軍174醫(yī)院既往有單側肺單一肺葉/亞肺葉切除史或因慢性支氣管炎、肺氣腫等肺部疾病病史,肺功能處于肺手術臨界值,一側肺多發(fā)肺內結節(jié)的10個住院患者作為研究對象,。術前采用320排CT的超薄層掃描做肺動脈CTA,CT圖像數據導入3D數字肺軟件進行三維重建,并以肺動脈系統(tǒng)為基礎進行肺段自動劃分,對肺內動靜脈、支氣管及肺結節(jié)進行三維重建,并自動劃出肺結節(jié)所屬肺段。同時3D數字肺軟件計算擬切除的病變肺段占全肺的體積比例,估算手術對第1秒肺活量(FEV1)的影響,評估患者對手術的耐受性。做好手術前規(guī)劃后,根據術前規(guī)劃的手術路徑在全麻下行胸腔鏡下同期多肺段/亞段切除術。結果:10個病例的肺動脈三維重建均能達到5級以下分支水平,并自動劃分出肺段,清楚顯示肺內結節(jié)所在肺段/亞段,清晰的顯示段支氣管、肺動脈及肺結節(jié)的關系,降低了因支氣管或肺血管變異時導致副損傷的風險。10個病例預切除肺體積占全肺體積13%-27%。估算術后FEV1為1.16-1.65L,能耐受手術。10個病例均順利施行全麻胸腔鏡下多個肺段/亞段切除術,術中未出現(xiàn)臨近支氣管、肺動靜脈等副損傷情況,切下肺段立即解剖找到肺內結節(jié),并送快速病理檢查明確診斷。術后患者恢復順利,無呼吸功能不全表現(xiàn),術后住院時間4-5天。結論:3D數字肺軟件,不但可以自動劃分肺段,精確定位肺內結節(jié)位置,顯示目標肺段動靜脈、支氣管與周圍動靜脈、支氣管的關系,有利于降低術中副損傷的風險;還能計算病變肺段的體積,估算手術對FEV1的影響,幫助術者準確的、量化的評估多發(fā)肺內結節(jié)患者對同期多肺段切除術的耐受性。從而更有利于患者的手術安全及術后的生活質量。
[Abstract]:Objective: to investigate the accuracy of preoperative localization of pulmonary nodules in patients with multiple pulmonary nodules with low pulmonary function reserve by 3D digital lung segment automatic division / virtual surgery software. Experience and experience in predicting pulmonary function after pulmonary nodule operation and guiding simultaneous multi-segmental resection under thoracoscope. Methods: from December 2014 to February 2017, 174 Hospital of the Chinese people's Liberation Army had a history of unilateral lung lobectomy / sublobectomy or a history of chronic bronchitis, emphysema and other pulmonary diseases, and the lung function was at the critical value of lung surgery. Ten inpatients with multiple pulmonary nodules in one lung were studied. The CT data of pulmonary artery were imported into 3D digital lung software to reconstruct the pulmonary artery with ultrathin slice scan of 320 slice CT before operation. The pulmonary segment was divided automatically based on pulmonary artery system, and the pulmonary artery and vein, bronchus and pulmonary nodule were reconstructed. The pulmonary nodules belong to the lung segment. At the same time, 3D digital lung software was used to calculate the volume ratio of the diseased lung segment to the whole lung, to estimate the effect of the operation on the first second vital capacity and FEV1), and to evaluate the patient's tolerance to the operation. After preoperation planning, multiple lung segmental / subsegmental resection was performed under general anesthesia according to the planned operation path before operation. Results: the three dimensional reconstruction of pulmonary artery in 10 cases could reach the level of subgrade 5 branches, and the pulmonary segments could be divided automatically. The pulmonary segments / subsegments of the pulmonary nodules were clearly displayed, and the relationship among segmental bronchi, pulmonary arteries and pulmonary nodules was clearly displayed. Reduced risk of collateral damage due to bronchi or pulmonary vascular abnormalities. 10 cases with preresectomized lung volume 13-27. The postoperative FEV1 was estimated to be 1.16-1.65L. all the 10 patients underwent thoracoscopic resection of multiple lung segments / subsections under general anesthesia without collateral injury such as adjacent bronchus, pulmonary arteriovenous injury, etc. The pulmonary nodules were dissected immediately after resection. The diagnosis was confirmed by rapid pathological examination. The patient recovered smoothly and had no respiratory insufficiency. The postoperative hospital stay was 4-5 days. Conclusion3D digital lung software can not only automatically divide the lung segment, accurately locate the location of pulmonary nodule, but also show the relationship between the target lung segment arteriovenous, bronchus and peripheral arteriovenous, bronchus, which is helpful to reduce the risk of collateral injury during operation. It can also calculate the volume of the diseased lung segment, estimate the effect of operation on FEV1, and help the operator to evaluate accurately and quantitatively the tolerance of patients with multiple pulmonary nodules to multiple segmental pneumonectomy at the same time. So it is more conducive to the patient's operation safety and postoperative quality of life.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：TP311.52;R734.2
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本文編號：1871151