摘要
目的探讨混合现实技术在肝胆外科手术中的应用。方法回顾性分析2019年1月至12月清华大学附属北京清华长庚医院收治的7例接受混合现实技术辅助肝胆手术病人临床资料,包括泡型肝棘球蚴病3例、肝内胆管结石1例、胆管囊状扩张症1例、肝胚胎性肉瘤1例及亲体肝移植供者1例。病人均行腹部增强CT检查,将数据运用结合人工智能全定量混合现实技术(QMR)进行术前评估、规划手术方案,并在真实手术空间环境中映射还原全息化的器官三维重建模型,与病人的器官、脉管、肿瘤等解剖结构进行实时融合匹配显示,获得手术部位的"透视"量化三维信息,进行术中导航并显示肝脏体积等数据。随访终点为手术后6个月。结果病人中位年龄35(10~43)岁。7例病人的全息图像配准操作与术者手术过程同步进行,中位手术时长12.12(6.17~14.25)h,中位出血量800(100~1500)m L,中位术后住院日14(7~23)d。术后有1例病人出现肠肠吻合口出血并发症,再次行手术止血。其余均无术后并发症,无围手术期死亡。术中导航匹配情况,术中混合现实导航与实际解剖结构配准。7例病人QMR中位配准时长7(5~10)min,占手术时长1.19%(0.80%~1.41%)。配准后间断使用术中导航分辨重要解剖结构,包括肝总动脉3例、肝固有动脉6例、肝左静脉3例、肝中静脉2例、肝右静脉3例及门静脉5例。同时还利用导航进行胆管解剖保护,处理胆总管5例,左肝管3例、右肝管2例。肝切面导航7例,配准误差7(2~17)mm。7例病人均接受规律回访至术后6个月,术后至随访终点恢复良好,肿瘤病人未见复发。结论QMR可量化提取、构建及术中映射、还原、配准三维结构的关键信息,术者可实时与之交互,用于评估和导引切除计划的实施,从而辅助肝胆外科手术实现可视化、可量化、可控化的精准切除目标。
ObjectiveTo investigate the application of mixed reality technology in hepatobiliary surgery.MethodsA retrospective research was conducted to analyze the clinicopathological data of 7 patients who underwent mixed reality technology-assisted hepatobiliary surgery from January to December 2019 in Beijing Tsinghua Changgung Hospital of Tsinghua University.Seven patients included 3 cases of alveolar hepatic hydatid disease,1 case of intrahepatic bile duct stones,1 case of cystic dilatation of the bile duct,1 case of hepatic embryonic sarcoma and 1 case of a parent liver transplant donor.The patients underwent enhanced abdominal computed tomography(CT).The data of enhanced CT scan was combined with artificial intelligence QMR(Quantitative Mixed Reality)technology for preoperative evaluation and planning of the surgery.Reconstructed the three-dimensional(3 D)holographic organ which displayed in real-time fusion and matching with the anatomical structures of the recipient’s organs,vessels,tumors and so on in the real surgical environment,aiming to obtain the"perspective"quantitative three-dimensional information of the surgical site,perform intraoperative navigation and collect data such as liver volume.The endpoint of follow-up was 6 months later after surgery.Results operation of 7 patients was performed synchronouslywith the operation process by surgeon.The medianoperation time was 12.12(6.17—14.25)h,and themedian blood loss was 800(100—1500)m L,themedian postoperative hospitalization was 14(7—23)d.After the operation,one patient had complications of intestinal anastomosis bleeding,and the second operation wasperformed to stop the bleeding.The rest recovered without postoperative complications nor perioperative death.Intraoperative navigation matching situation,intraoperative mixed reality navigation were matched with actual anatomicalstructure registration.The median QMR registration duration of 7 patients was 7(5—10)min,which accounted for 1.19%(0.80%—1.41%)of the whole operation time.After registration,intraoperative navigation was utilized intermittently todistinguish important anatomical structures,including 3 cases of common hepatic artery,6 cases of proper hepatic artery,3 cases of left hepatic vein,2 cases of middle hepatic vein,3 cases of right hepatic vein,and 5 cases of portal vein.At thesame time,navigation was used for bile duct anatomy protection,and 5 cases of common bile duct,3 cases of left hepaticduct and 2 cases of right hepatic duct were processed.The QMR system accurately displayed 7 cases of sectionnavigation,with a registration error of 7(2—17)mm.Follow-up status:7 patients received regular follow-up visits to 6 months later after surgery,and recovered well until the end of follow-up.There was no recurrence in tumor patients.ConclusionFull quantitative mixed reality technology can quantitatively extract,construct,navigate,restore,andregister key information of the 3 D structure during the operation.The surgeon can interact with it in real time to evaluateand guide the implementation of the resection plan,thereby assisting hepatobiliary surgery to achieve visualization,quantification,and controllable precise resection targets.
作者
杨威
汤睿
童翾
周呈瑶
李昂
于里涵
闫军
刘江
卢倩
YANG Wei;TANG Rui;TONG Xuan(Department of Hepatobiliary and Pancreatic Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,Clinical Medical College of Tsinghua University,Precision Medicine Institute of Tsinghua University,Beijing 102218,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第3期298-305,共8页
Chinese Journal of Practical Surgery
基金
北京清华长庚医院青年启动基金(No.12019C1010)。
关键词
肝胆外科
混合现实技术
三维重建
肝脏切除手术
手术导航
hepatobiliary surgery
mixed reality technology
three-dimensional reconstruction
liver resection
surgical navigation
