三维可视化融合成像导航系统在腹腔镜胰腺手术中的应用价值

Application value of three dimensional imaging fusion navigation system in laparoscopic pan-creatic surgery

目的:探讨三维可视化融合成像导航系统(以下简称导航系统)在腹腔镜胰腺手术中的应用价值。方法:采用回顾性描述性研究方法。收集2020年12月至2021年5月河北医科大学第二医院收治的2例志愿者(志愿者1为胆管癌行腹腔镜胰十二指肠切除术、志愿者2为胰腺癌行腹腔镜胰体尾+脾切除术)的临床资料;均为女性;年龄分别为68岁、40岁。采用自主研发的导航系统进行腹腔镜训练器模型(刚体模型、假体模型)测试和临床测试研究。观察指标:(1)模型测试情况。(2)临床测试情况。正态分布的计量资料以x±s表示。结果:(1)模型测试情况。初始腹腔镜模拟训练器的腹腔镜视野可见有遮挡物的刚体模型或假体模型。增强CT检查三维可视化重建可见有遮挡物的刚体模型或假体模型和隐去遮挡物的刚体模型或假体模型。三维可视化重建图像与腹腔镜实时画面叠加融合成像后,腹腔镜模拟训练器的腹腔镜视野可见被遮挡的刚体模型或假体模型。刚体模型吻合度良好,标志点距离误差为(0.26±0.11)mm;假体模型吻合度良好,标志点距离误差为(0.29±0.18)mm。(2)临床测试情况。2例志愿者初始腹腔镜视野可见有遮挡的腹腔脏器和血管;增强CT检查三维可视化重建后,导航系统可显示肿瘤、重要脏器及重要血管的位置;三维可视化重建图像与腹腔镜实时画面叠加融合成像后,腹腔镜视野可显示肿瘤、重要脏器及重要血管的位置。志愿者1血管标志点距离误差为(1.36±0.57)mm;志愿者2血管标志点距离误差为(1.24±0.33)mm。结论:导航系统运用于腹腔镜胰腺手术效果满意,腹腔镜视野中能够显示常规腹腔镜胰腺手术无法明确的深层组织和血管关系。

Objective To investigate the application value of three dimensional(3D)imaging fusion navigation system(hereinafter referred as navigation system)in laparoscopic pan-creatic surgery.Methods The retrospective and descriptive study was conducted.The clinical data of two volunteers,including volunteer 1 undergoing laparoscopic pancreaticoduodenectomy for cholangiocarcinoma and volunteer 2 undergoing laparoscopic pancreaticotomy+splenectomy for pancreatic cancer,who were admitted to the Second Hospital of Hebei Medical University from December 2020 to May 2021 were collected.The 2 volunteers were females,aged 68 years and 40 years,respectively.The self-developed navigation system was applied in laparoscopic simulator model test,including in rigid-body model and prosthesis model,and clinical test.Observation indicators:(1)results of model test;(2)results of clinical test.Measurement data with normal distribution were represented as Mean±SD.Results(1)Results of model test.The rigid-body model or prosthesis model with occlusion can be seen in the laparoscopic visual field of the initial laparoscopic simulator.The rigid-body model or prosthesis model with occlusion and rigid-body model or prosthesis model without occlusion can be seen in the 3D visual reconstruction image of enhanced computer tomography(CT)examination.The rigid-body model or prosthesis model with occlusion can be seen in the laparoscopic visual field of the initial laparoscopic simulator after the 3D visual reconstruction image was superimposed and fused with the real-time laparoscopic image.Both of the rigid-body model and prosthesis model were in high consistency,with the distance error of marker points were(0.26±0.11)mm and(0.29±0.18)mm,respectively.(2)Results of clinical test.The abdominal organs and blood vessels with occlusion of the 2 volunteers can be seen in the initial laparoscopic visual field.The location of tumor,important organs and blood vessels can be seen in the navigation system using the 3D visual reconstruction image of enhanced CT examination.The location of tumor,important organs and important blood vessels can be seen in the laparoscopic visual field after the 3D visual reconstruction image was superimposed and fused with the real-time laparoscopic image.The distance error of marker points of the volunteer 1 was(1.36±0.57)mm and the distance error of marker points of the volunteer 2 was(1.24±0.33)mm.Conclusions The self-developed navigation system can integrate the preoperative 3D visual reconstruction image of enhanced CT examination and the intraoperative real-time laparoscopic image with a good effect.The relationship between deep tissue and blood vessels which is not clarified in conventional laparoscopy can be shown in the navigation system assisted laparoscopic pancreatic surgery.