發(fā)布時間：2018-05-31 04:10

  本文選題：頭頸部腫瘤 + 動態(tài)增強計算機斷層掃描　； 參考：《北京大學(xué)學(xué)報(醫(yī)學(xué)版)》2017年05期

【摘要】：目的:應(yīng)用iPlan CMF軟件重建頭頸部腫瘤患者增強CT影像中的腫物及周圍重要解剖結(jié)構(gòu),探討iPlan CMF指導(dǎo)下增強CT三維重建技術(shù)在頭頸部腫瘤手術(shù)治療中的臨床意義。方法:選取2014年6月至2015年6月就診于北京大學(xué)口腔醫(yī)學(xué)院口腔頜面外科的13例頭頸部腫瘤緊鄰重要神經(jīng)、血管的患者,利用Seimens 16排螺旋CT薄層掃描技術(shù),以額定掃描參數(shù)完成頭頸部增強掃描,iPlan CMF軟件直接讀入Dicom格式原始數(shù)據(jù),利用表面陰影重建法分別重建腫瘤、血管、骨骼及其他重要解剖結(jié)構(gòu),顯示其術(shù)前三維空間關(guān)系,測量標(biāo)記腫瘤與重要血管等解剖結(jié)構(gòu)的距離,視腫瘤觀察需要可行虛擬截骨,完成腫瘤暴露,設(shè)計手術(shù)入路,用以指導(dǎo)術(shù)前準(zhǔn)備及手術(shù)。收集13例患者的術(shù)前準(zhǔn)備、術(shù)中情況及術(shù)后并發(fā)癥情況。結(jié)果:13例患者中,男6例,女7例,年齡23~65歲,中位年齡50歲。觀察三維重建圖像,可以清晰顯示腫瘤范圍、大小、位置及其與周圍臨近重要解剖結(jié)構(gòu)的關(guān)系,根據(jù)三維重建圖像,評估13例患者的手術(shù)風(fēng)險,3例患者經(jīng)過腫瘤三維重建等術(shù)前評估,建議綜合治療;10例患者完成術(shù)前準(zhǔn)備并成功完成手術(shù),其中3例患者術(shù)前備血及術(shù)中輸血,2例患者邀請神經(jīng)外科、胸外科協(xié)助手術(shù),10例患者手術(shù)平均用時(202±135)min,手術(shù)平均出血(235±252)m L,三維標(biāo)記與術(shù)中情況符合率為100%,其中1例患者由于腫瘤來源于迷走神經(jīng),術(shù)后出現(xiàn)聲音嘶啞,其余患者未出現(xiàn)手術(shù)并發(fā)癥。結(jié)論:利用iPlan CMF軟件三維重建增強CT可以清楚顯示頭頸部深大腫瘤的特征及其與周圍重要解剖結(jié)構(gòu)的關(guān)系,有利于手術(shù)方案的設(shè)計,避免術(shù)中損傷重要解剖結(jié)構(gòu),減少術(shù)后并發(fā)癥的產(chǎn)生。
[Abstract]:Objective: to study the clinical significance of three-dimensional enhanced CT reconstruction under the guidance of iPlan CMF in the surgical treatment of head and neck tumors. Methods: from June 2014 to June 2015, 13 patients with head and neck tumors adjacent to important nerves and blood vessels were selected from oral and maxillofacial surgery, School of Stomatology, Peking University. Seimens 16-slice spiral CT thin slice scanning technique was used. The original data of Dicom format were directly read into the CMF software of head and neck enhanced scanning with rated scanning parameters. The surface shadow reconstruction method was used to reconstruct tumor, blood vessel, bone and other important anatomical structures, respectively, and to show the three dimensional spatial relationship before operation. By measuring the distance between the tumor and the anatomic structure such as important blood vessels, virtual osteotomy was necessary for tumor observation, tumor exposure was completed, and an operative approach was designed to guide preoperative preparation and operation. The preoperative preparation, intraoperative condition and postoperative complications were collected in 13 patients. Results among the 13 patients, 6 were male and 7 female, aged 2365 years, with a median age of 50 years. The range, size, location of the tumor and its relationship with the adjacent important anatomical structures can be clearly displayed by observing the three-dimensional reconstruction images, according to the three-dimensional reconstruction images. To evaluate the surgical risk of 13 patients, 3 patients underwent three dimensional reconstruction of tumor before operation, and 10 patients were recommended for comprehensive treatment to complete preoperative preparation and successful operation. Among them, 3 patients had blood preparation before operation and 2 patients had invited neurosurgery during operation. The mean time of operation was 202 鹵135 min and the mean bleeding was 235 鹵252 min. The coincidence rate between 3D labeling and intraoperative conditions was 100. One patient developed hoarseness after operation because the tumor originated from vagus nerve. There were no surgical complications in the other patients. Conclusion: Three-dimensional reconstruction enhanced CT with iPlan CMF software can clearly display the features of deep large head and neck tumors and their relationship with the important anatomical structures around them, which is beneficial to the design of surgical schemes and to avoid the injury of important anatomical structures during operation. Reduce postoperative complications.
【作者單位】： 北京大學(xué)口腔醫(yī)學(xué)院·口腔醫(yī)院口腔頜面外科口腔數(shù)字化醫(yī)療技術(shù)和材料國家工程實驗室口腔數(shù)字醫(yī)學(xué)北京市重點實驗室;
【基金】：國家科技支撐計劃(2014BAI04B06) 北京市科委首都市民健康培育項目(Z161100000116053)資助~~
【分類號】：R739.91

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