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三维可视化技术在肝泡型包虫病外科治疗中的应用

Application of three-dimensional visualization technology in surgical treatment for patients with hepatic alveolar echinococcosis

摘要:

目的 探讨三维可视化技术在肝泡型包虫病的术前评估及手术规划中的应用价值.方法 回顾性收集2011年5月至2015年5月在新疆医科大学第一附属医院接受外科手术治疗的85例肝泡型包虫病患者的临床资料,利用患者术前64层CT数据,采用三维可视化技术对患者肝脏、肝内管道及病灶进行个体化三维重建,评估手术可行性和安全性,指导临床手术实施.通过比较术前和术中各项测量指标的差异来评估三维重建系统的准确性.结果 85例患者均行根治性手术治疗(根治性肝切除59例、自体肝移植26例),实际手术方案与术前三维重建虚拟手术设计的方案一致,三维重建对重要血管及胆管解剖学的评估结果与术中所见基本相符.利用三维可视化评估方法计算拟切除肝脏体积[(751 ±510)cm3]与术中实际切除肝脏质量[(777±567)g]呈正相关(r=0.990),测量误差率为4.7%;26例自体肝移植患者剩余肝脏体积[(873±258) cm3]与术中实际剩余肝脏质量[(850 ±267)g]呈正相关(r=0.975).所有患者术后随访6~ 46个月(平均11.3个月).随访期间死亡3例,复发2例,其中1例接受二次手术治疗后康复出院,1例拒绝手术治疗,给予药物治疗.结论三维可视化技术在肝泡型包虫病外科治疗术前评估及手术规划过程中有一定价值.

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abstracts:

Objective To determine the clinical value of three-dimensional (3D) visualization technology in pre-operative assessment and surgical planning for patients with hepatic alveolar echinococcosis.Methods Eighty-five hepatic alveolar echinococcosis patients received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University between May 2011 and May 2015.3D reconstruction and virtual surgeries were performed on diseased livers using a 3D visualization reconstruction system for liver,which based on the data set of 64-slice CT from those patients and indicated the feasibility and safety of liver resection.The pre-operative measurement results were compared with intra-operative conditions to verify the accuracy of pre-operative evaluation.Results All surgical strategies of patients underwent surgical treatment(59 of 85 received traditional liver resection and 26 of 85 received liver autotransplantation) were consistent with pre-operative surgical planning in 3D reconstruction.Furthermore,the pre-operative resection liver volume((751 ± 510)cm3) estimated by 3D calculation method was positively correlated with the actual weight ((777 ± 567) g) after the surgery (r =0.990),and the error rate was 4.7%;the pre-operative remaining liver volume((829 ± 157)cm3) estimated by 3D calculation method was positively correlated with the actual weight ((770 ± 206) g) after the surgery (r =0.978).Patients were followed for 6-46 months after the surgery,and 3 post-operative death and 2 recurrence (one case received secondary surgery and one case received drug therapy) were reported during the follow-up period.Conclusions A liver 3D visualization technology has application value in the pre-assessment and surgical planning.When it combined with ultrasound,CT and MRI,traditional examinations,the liver 3D visualization technology can effectively improve the success rate of operation,reduce the risks of surgery.

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