摘要目的 探讨以门静脉为轴心的Ⅲ、Ⅳ型肝门部胆管癌三维可视化(3DV)评估及虚拟现实(VR)研究的应用价值.方法 收集南方医科大学珠江医院经B超、CT诊断为Bismuth分型Ⅲ、Ⅳ型肝门部胆管癌10例患者的薄层CT图像数据导入三维可视化系统,进行三维图像重建,以门静脉为轴心进行3DV分析和评估;并将三维数据导入VR开发引擎,进行VR研究,制定手术规划;然后将二者影像数据带人手术室,用以导航手术.结果 10例患者均完成了3DV系统重建及VR模型转化.肿瘤按3DV系统肝门部胆管癌分型:Ⅱ型1例,Ⅲa型2例,Ⅲb型5例,Ⅳa型1例,Ⅳb型1例.门静脉按Cheng氏分型:Ⅰ型6例,Ⅱ型3例,Ⅲ型1例.肝动脉按Michels分型:Ⅰ型5例,Ⅱ型1例,Ⅲ型3例,Ⅸ型1例.10例患者均顺利完成手术,3DV评估及VR研究与术中所见基本一致,患者围手术期无肝功能衰竭及死亡.结论 以门静脉为轴心的3DV评估及VR研究,对Ⅲ、Ⅳ型肝门部胆管癌的手术治疗有着重要的指导意义.

abstractsObjective To explore the application value of three-dimensional visual (3DV) assessment and virtual reality (VR) study of type Ⅲ and Ⅳ hilar cholangiocarcinoma with portal vein as the axis.Methods The CT image data of 10 patients who were diagnosed as Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma by B-ultrasound and CT in Zhujiang Hospital,Southern Medical University were imported into 3D visualization system (3DVS) for 3D image reconstruction,and the portal vein was used as the axis for 3DV analysis and evaluation.The 3D data were then imported into the VR development engine to perform VR research,so as to help the operation planning.Both of the image data were taken into the operation room for intraoperative navigation.Results 10 patients completed 3D visualization reconstruction and VR model transformation.According to the 3D visualization of hepatic hilar hepatocarcinoma,there were 1 case of type Ⅱ,2 cases of type Ⅲa,5 cases of type Ⅲb,1 case of type Ⅳa and 1 case of type Ⅳb.The portal vein was classified according to Cheng type:6 cases of type Ⅰ,3 cases of type Ⅱ,and 1 case of type Ⅲ.The hepatic artery was classified according to Michels type:5 cases of type Ⅰ,1 case of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅸ.The 3DV assessment and VR study were almost consistent with the intraoperative findings.No liver failure or death occurred during the perioperative period.Conclusion The 3DV assessment and VR study with the portal vein as the axis have potential application for the surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.