仿真手术在肝移植2型肝动脉变异动脉重建中的应用价值

Value of virtual surgery in arterial reconstruction in liver recipients with type II hepatic artery variation

目的研究可视化仿真手术在肝移植供受者2型肝动脉变异动脉重建的应用价值。方法收集1例肝癌患者和1例未发现肝脏疾病的健康人64排螺旋CT扫描数据,在自主研发的图像程序分割重建系统进行程序分割、三维重建,然后导入到FreeForm Modeling System进行修饰和平滑,利用系统的力反馈设备进行肝移植肝动脉重建的仿真手术研究。结果重建的模型具有肝脏、肝动脉、胆道系统、胆道癌栓及肿瘤,完整的显示肝动脉分支,肝动脉类型属II型肝动脉变异。在建立的仿真环境中,使用PHANToM操纵仿真手术刀及仿真缝针模拟了肝移植供体带补片的腹腔干与受者腹主动脉吻合的动脉重建手术过程。结论可视化的重建模型有助于了解动脉的空间结构总体观,有利于肝移植术前准备及动脉重建手术方案的合理选择;节省肝移植术动脉重建的时间,降低手术风险及手术并发症。

Objective To investigate the value of virtual surgery in hepatic artery reconstruction in liver recipients with type Ⅱ hepatic artery variation. Methods A patient with cholangiocellular carcinoma and a healthy individual were scanned using 64-slice spiral CT, and image segmentation and three-dimensional （3D） reconstruction were performed using an image processing system. The 3D models in STL format were then imported to the FreeForm Modeling System for smoothing and refinement. Hepatic artery reconstruction was performed in simulated liver transplantation using the virtual surgery system with force feedback （PHANTOM）. Results The reconstructed modelcontained the liver, hepatic arteries, biliary system, and bile duct tumor emboli and displayed the entire branching of the hepatic artery with type Ⅱ variation. Using the virtual surgery system, arterial reconstruction was performed by anastomosing the donor celiac trunk and the recipient abdominal aorta with the virtual scalpel and needle. Conclusion The reconstructed model allows clearer views of the 3D structures of the arteries in the liver and helps in preoperative preparations and surgical planning of artery reconstruction during liver transplantation. This approach may also help reduce the surgical risks and potential complications.