三维影像融合重建技术在消融中心临床教学中的探索与实践

Exploration and Practice of 3D Modeling Technology for Clinical Teaching in Tumor Ablation Center

目的探讨和评估术前三维影像融合重建技术模拟消融过程对在浙江大学医学院附属第二医院行消融培训的专科进修医生的临床教学价值。方法2020年1—12月,选择在浙江大学医学院附属第二医院进行临床消融培训的30名进修医生作为研究对象,根据是否在消融操作前进行三维影像融合重建的模拟训练分为对照组和观察组,对照组术前集中阅片了解肿瘤大小、位置等信息,制定手术策略,观察组运用三维影像融合重建技术,通过模拟消融过程制定手术策略,进修结束后进行消融技术评估和进修满意度问卷调查。结果在手术熟练度和精确度方面,观察组运用超声寻找病灶的速度和总的手术时间均明显优于对照组,差异有统计学意义(P<0.05);在术后并发症发生率和术后肿瘤残留率方面优于对照组,但差异无统计学意义(P>0.05);在进修满意度方面,观察组在影像读片、超声操作、穿刺技巧和消融操作方面的满意度均明显优于对照组,差异均有统计学意义(P<0.05)。结论三维影像融合技术应用于肿瘤消融的培训,能够改善消融培训过程中实际操作不足,医生对穿刺技术生疏的困境,有助于进修医生更快地掌握肿瘤消融技术。

Objective To explore and evaluate the clinical teaching value of preoperative three-dimensional image fusion and reconstruction technology to simulate the ablation process for refresher medical specialists who received ablation training in our center.Methods A total of 30 refresher doctors for ablation learning from January to December 2020 in the Second Affiliated Hospital of Zhejiang University School of Medicine were invited to participate this study.They were divided into the control group and the observation group according to the simulation training of whether or not to perform three-dimensional image fusion and reconstruction before ablation operation.In the control group,the tumor size,location and other information were centrally read before operation to formulate surgical strategies.In the observation group,three-dimensional image fusion and reconstruction technology were used to simulate the ablation process to formulate surgical strategies.A careful evaluation of the improvement on the puncture and ablation technique and questionnaire survey for the further education period were performed when they finished their learning in the hospital.Results In terms of operation proficiency and accuracy,the speed of finding lesions by ultrasound and the total operation time in the observation group were significantly better than those in the control group,with statistical significance(P<0.05).The incidence of postoperative complications and tumor residual rate were better than those of the control group,but the difference was not statistically significant(P>0.05).In terms of satisfaction with further education,the observation group was significantly better than the control group in terms of image reading,ultrasound operation,puncture skills and ablation operation,with statistical significance(P<0.05).Conclusion Ablation simulation based on 3D modeling technology is helpful for clinical teaching of tumor ablation.It can be used to improve the puncture and ablation technique of refresher doctors.