三维可视化技术在精准肝胆管结石诊治中的应用[J].pdfVIP

2011;31(6) 南方医科大学学报（J South Med Univ ） ·949 · ·临床研究· 三维可视化技术在精准肝胆管结石诊治中的应用 范应方，方驰华，陈建新，项 楠，杨 剑，李克晓 南方医科大学珠江医院肝胆一科，广东 广州 510282 摘要：目的 探索三维可视化技术在肝胆管结石病术前诊断、术前评估及手术指导方面的应用价值。方法对30 例肝胆管 结石病人的肝脏64 排螺旋CT 扫描原始数据，采用自主研发的腹部医学图像处理系统进行肝脏及胆道三维重建，根据三 维重建结果进行术前诊断和病理分型，评估手术预案可行性及安全性，确定最佳手术方案后指导临床实际手术过程；并观 察术中所见与仿真手术的符合程度以及患者结石残留情况。结果当肝脏设置为半透明时，可以清晰显示肝内、外胆管的 立体解剖形态，病变胆管扩张及狭窄部位和程度，肝内结石的精确部位、大小及数量。术中所见与术前三维重建符合率、 实际手术过程与术前仿真手术符合率均为100% ，实际手术方案与术前预案符合率达到90%（27/30）。随访半年，复发率 7.4%（2/27）。结论三维可视化技术可实现肝胆管结石病的术前精确诊断和术中精确操作，可有效降低术后复发率。 关键词：肝胆管结石；三维可视化；腹部医学图像处理系统 中图分类号：R657.42 文献标志码：A 文章编号：1673-4254（2011）06-0949-06 Application of three-dimensional visualization technology in precise diagnosis and treatment for hepatolithiasis FAN Ying-fang, FANG Chi-hua, CHEN Jian-xin, XIANG Nan, YANG Jian, LI Ke-xiao First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China Abstract: Objective To assess the value of three-dimensional (3D) visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis. Methods The 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shape