复合手术室智能移动三维导航技术在近肾型腹主动脉瘤腔内治疗中的应用效果评价

Clinical application of three-dimensional navigation technology in endovascular treatment of proximal renal abdominal aortic aneurysm

目的:探讨复合手术室术中智能移动三维导航技术在近肾型腹主动脉瘤腔内治疗中的应用价值。方法:选取2016年2月-2018年6月在江苏省苏北人民医院复合手术室治疗的7例近肾型腹主动脉瘤患者,术中行数字减影血管造影三维成像(3D-DSA)后将3D重建图像和2D透视图像进行图像融合,标记肾动脉及其他重要血管分支。并对不同阶段不同体位的术中三维导航融合图像进行自动修正配准,根据手术需要,改善融合图像的血管、骨骼背景密度,提高叠加图像上血管可视化程度,精确指导支架释放,实现血管内治疗的准确导航。结果:7例患者在3D图像导航下行血管腔内腹主动脉瘤修复术,导丝导管均成功导入靶血管内,单根靶血管导入时间3~22 min,造影剂用量150~180 ml。7例行血管腔内腹主动脉瘤修复术均手术成功,术后即刻造影提示分支血管显影通畅,无内漏。结论:复合手术室三维导航技术可精准标记肾动脉及其他分支血管开口,方便术中靶血管定位超选,对近肾型腹主动脉瘤腔内治疗具有重要的指导作用。

Objective:To explore the application value of intelligent mobile 3D navigation technology in hybrid operating room in endovascular treatment of proximal renal abdominal aortic aneurysm.Methods:The clinical data of 7 patients with proximal renal abdominal aortic aneurysm treated in the hybrid operating room from February 2016 to June 2018 were retrospectively analyzed.During the operation,after 3D-DSA(digital subtraction angiography three-dimensional imaging)has been done,3D reconstruction image and 2D(2D imaging)perspective image were fused,renal artery and other important branch blood vessels were marked in the process of operation.In addition,the intraoperative 3D navigation fusion images in different stages and positions were automatically modified.According to the requirements of the operation,the background density of blood vessels and bones in the fusion image should be improved,so the vascular visibility in the superimposed image were improved,and the stent release should be guided accurately.Therefore,the purpose of accurate navigation in the endovascular treatment is achieved.Results:The guidewire and catheter were successfully selected into the target vessel by the 3D navigation.Stents were all released accurately,and angiography indicated the aneurysms were successfully isolated without endoleak.Conclusions:The openings of renal arteries and other vessel branches can be accurately marked by the three-dimensional navigation technology in the hybrid operating room,It is convenient to select target blood vessel during the operation.This technology plays an important role in guiding the endovascular treatment of proximal renal abdominal aortic aneurysm.