本文關(guān)鍵詞：肝臟靜脈三維重建及肝內(nèi)門(mén)體靜脈分流術(shù)穿刺入路可視化研究　出處：《第三軍醫(yī)大學(xué)》2007年博士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 肝內(nèi)靜脈管道 門(mén)體靜脈分流 斷面解剖 重采樣 三維重建 可視化

【摘要】： 肝臟是人體內(nèi)體積最大、具有重要生理功能的臟器。肝臟管道系統(tǒng)的肝靜脈系、門(mén)靜脈系及肝后段下腔靜脈的解剖結(jié)構(gòu)交錯(cuò)重疊、相互關(guān)系復(fù)雜,是肝內(nèi)血管介入治療和肝臟手術(shù)切除的難點(diǎn)。經(jīng)頸靜脈肝內(nèi)門(mén)體靜脈分流術(shù)(Transjugular Intrahepatic Portosystemic Shunt, TIPS)是近年來(lái)發(fā)展起來(lái)的一項(xiàng)專門(mén)治療門(mén)靜脈高壓癥的介入放射學(xué)新技術(shù),它采用多項(xiàng)介入技術(shù),在門(mén)靜脈和腔靜脈之間通過(guò)介入器械搭建一個(gè)有效的靜脈分流通道,使部分門(mén)靜脈血流直接匯入下腔靜脈而回流入心,治療由于肝硬化等疾病所引起的門(mén)靜脈高壓。該技術(shù)操作的關(guān)鍵是準(zhǔn)確掌握肝臟靜脈管道間解剖結(jié)構(gòu)的空間關(guān)系,設(shè)計(jì)適合導(dǎo)管介入治療的路徑,選擇正確的穿刺點(diǎn)和適宜的分流通道,建立穩(wěn)定而持久的肝內(nèi)靜脈分流途徑,避免在手術(shù)操作中損傷毗鄰的重要結(jié)構(gòu)。 本實(shí)驗(yàn)應(yīng)用數(shù)字化可視人體數(shù)據(jù)集,選擇自頸內(nèi)靜脈平面至肝臟下緣平面的連續(xù)薄層橫斷面圖像序列,經(jīng)精確配準(zhǔn)后進(jìn)行計(jì)算機(jī)圖像重采樣處理獲取TIPS術(shù)路徑的橫斷面、冠狀斷面和矢狀斷面三個(gè)方位的連續(xù)薄層斷面圖像數(shù)據(jù)集,并對(duì)各方位斷面圖像進(jìn)行斷層解剖學(xué)結(jié)構(gòu)觀察和數(shù)據(jù)測(cè)量;運(yùn)用圖像分割軟件,采取對(duì)連續(xù)斷面解剖結(jié)構(gòu)追蹤顯示的方法,分別對(duì)數(shù)據(jù)集中的頸內(nèi)靜脈、頭臂靜脈、上腔靜脈、心臟、下腔靜脈、肝靜脈和門(mén)靜脈結(jié)構(gòu)進(jìn)行數(shù)據(jù)分割和邊界提取,并在計(jì)算機(jī)上進(jìn)行TIPS術(shù)路徑及其改良術(shù)式-直接性門(mén)腔靜脈分流術(shù)(Direct Intrahepatic Portacaval Shunt, DIPS)路徑的三維重建,構(gòu)建肝內(nèi)門(mén)體分流三維模型,并觀測(cè)和比較TIPS術(shù)與DIPS術(shù)路徑的空間結(jié)構(gòu)關(guān)系、穿刺路線和內(nèi)支架位置;利用可視化軟件,采用交互手動(dòng)分割和自動(dòng)閾值分割相結(jié)合的數(shù)據(jù)提取法進(jìn)行圖像分割,在圖形工作站上完成經(jīng)頸靜脈肝內(nèi)門(mén)體靜脈分流術(shù)路徑的三角形網(wǎng)格表面重構(gòu),構(gòu)建肝內(nèi)門(mén)體靜脈分流的三維可視化模型,實(shí)現(xiàn)在可視化平臺(tái)基礎(chǔ)上進(jìn)行立體觀察和三維測(cè)量;應(yīng)用虛擬內(nèi)窺鏡(Virtual Endoscopy, VE)技術(shù),在肝內(nèi)門(mén)體分流三維重建模型和可視化平臺(tái)的基礎(chǔ)上,進(jìn)行經(jīng)頸靜脈至肝內(nèi)門(mén)靜脈管道內(nèi)介入導(dǎo)管的虛擬內(nèi)窺鏡的漫游和觀察,模擬介入穿刺針進(jìn)行經(jīng)肝靜脈至肝內(nèi)門(mén)靜脈的門(mén)體靜脈分流和經(jīng)肝后段下腔靜脈至肝內(nèi)門(mén)靜脈的門(mén)體靜脈分流的虛擬穿刺。主要研究結(jié)果如下: 1.應(yīng)用數(shù)字化可視人體數(shù)據(jù)集,選擇自頸內(nèi)靜脈平面至肝臟下緣平面連續(xù)薄層橫斷面圖像序列,經(jīng)精確配準(zhǔn)后完成計(jì)算機(jī)圖像重采樣,獲取經(jīng)頸靜脈肝內(nèi)門(mén)體靜脈分流術(shù)路徑的橫斷面、冠狀斷面和矢狀斷面三個(gè)方位的連續(xù)薄層斷面的圖像數(shù)據(jù)集,實(shí)現(xiàn)了對(duì)同一例標(biāo)本進(jìn)行多方位的斷面圖像信息獲取。 2.在圖像數(shù)據(jù)集上完成了對(duì)斷層圖像橫斷面、冠狀斷面和矢狀斷面多方位斷層解剖結(jié)構(gòu)的觀察及比較,斷面圖像結(jié)構(gòu)完整、圖像清晰,闡明了各方位肝內(nèi)靜脈管道的形態(tài)學(xué)特點(diǎn),并獲取斷面圖像二維測(cè)量資料,為肝內(nèi)門(mén)體靜脈分流術(shù)提供斷面解剖學(xué)形態(tài)依據(jù)。 3.運(yùn)用圖像分割軟件,采取對(duì)連續(xù)斷面解剖結(jié)構(gòu)追蹤顯示模式,對(duì)經(jīng)頸靜脈肝內(nèi)門(mén)體靜脈分流術(shù)路徑的主要結(jié)構(gòu)進(jìn)行了數(shù)據(jù)分割和邊界提取,在計(jì)算機(jī)上構(gòu)建了肝內(nèi)門(mén)體靜脈分流術(shù)路徑的三維重建模型,觀測(cè)并比較了TIPS術(shù)和DIPS術(shù)穿刺入路重建結(jié)構(gòu)的空間關(guān)系,獲取了穿刺路線和虛擬內(nèi)支架三維數(shù)據(jù),為肝內(nèi)門(mén)體靜脈分流術(shù)的穿刺入路提供了立體形態(tài)學(xué)依據(jù)。 4.利用可視化軟件,采用手動(dòng)交互分割和自動(dòng)閾值分割相結(jié)合的圖像數(shù)據(jù)提取方式在圖形工作站上完成經(jīng)頸靜脈肝內(nèi)門(mén)體靜脈分流術(shù)路徑的表面重構(gòu),構(gòu)建了肝內(nèi)門(mén)體靜脈分流的三維可視化模型,實(shí)現(xiàn)了在可視化平臺(tái)基礎(chǔ)上的立體觀察和三維測(cè)量,為肝內(nèi)門(mén)體靜脈分流術(shù)進(jìn)一步深入研究提供了可視化平臺(tái)和三維結(jié)構(gòu)數(shù)據(jù)。 5.應(yīng)用虛擬內(nèi)窺鏡技術(shù),在肝內(nèi)門(mén)體靜脈分流術(shù)路徑的三維可視化平臺(tái)上,完成了肝臟靜脈管道內(nèi)介入導(dǎo)管的虛擬內(nèi)窺鏡漫游和觀察,以內(nèi)窺鏡的視角清晰、生動(dòng)地顯示并描述了TIPS術(shù)路徑和DIPS術(shù)路徑管道內(nèi)部結(jié)構(gòu)特征。 6.在圖形工作站上,模擬了介入手術(shù)穿刺針進(jìn)行經(jīng)肝靜脈至肝內(nèi)門(mén)靜脈的門(mén)體靜脈分流和經(jīng)肝后段下腔靜脈至肝內(nèi)門(mén)靜脈的門(mén)腔靜脈分流的虛擬穿刺,演示了靜脈穿刺入路的路徑和過(guò)程,為建立肝臟血管內(nèi)介入手術(shù)模擬訓(xùn)練系統(tǒng)奠定了基礎(chǔ)。 7.依據(jù)肝內(nèi)靜脈管道特點(diǎn),在三維可視化模型基礎(chǔ)上設(shè)計(jì)了肝內(nèi)門(mén)體靜脈的介入導(dǎo)管的穿行路徑和穿刺入路,比較了TIPS術(shù)和DIPS術(shù)路徑穿刺入路的特點(diǎn),為肝內(nèi)門(mén)體靜脈分流術(shù)提供了術(shù)前規(guī)劃并制定合理的個(gè)性化介入手術(shù)方案的初步的計(jì)算機(jī)模型。
[Abstract]:Transthoracic Intrahepatic Portosystemic Shunt is a new technique for the interventional radiology of portal hypertension . Transthoracic Intrahepatic Portosystemic shunt ( transjugular intrahepatic portosystemic shunt ) is a new technique for the interventional therapy of portal hypertension . The three - dimensional visualization model of intrahepatic portacaval portacaval shunt ( DIPS ) is used to study and compare the three - dimensional reconstruction of portal vein , portal vein , superior vena cava , heart , inferior vena cava , hepatic vein and portal vein . 1 . The digital visual human data set is applied to select the continuous thin - layer cross section image sequence from the plane of the internal jugular vein to the lower edge of the liver , and after the accurate registration , the computer image is re - sampled , and the image data set of the cross section , the coronal section and the sagittal section of the jugular intrahepatic portal vein shunt path is acquired , and the multi - azimuth cross section image information acquisition is realized for the same specimen specimen . 2 . The cross section , coronal section and sagittal section multi - azimuth fault anatomical structure are observed and compared on the image data set . The section image structure is complete , the image is clear , the morphological characteristics of each azimuth hepatic vein duct are clarified , and the two - dimensional measurement data of the section image is acquired , which provides the basis for sectional anatomy for the hepatic portal vein shunt . 3 . Using image segmentation software , the main structure of portal vein shunt was divided and extracted . The three - dimensional reconstruction model of portal vein shunt was constructed on the computer . The spatial relationship between transjugular approach and DIPS was compared . The three - dimensional data of puncture route and virtual inner stent were obtained . 4 . Using the visualization software , the surface reconstruction of the portal vein shunt in the jugular intrahepatic portal vein is accomplished by using the image data extraction method combined with manual interaction segmentation and automatic threshold segmentation , and the three - dimensional visualization model of the hepatic portal vein shunt is constructed . The three - dimensional observation and the three - dimensional measurement on the visualization platform are realized , and the visualization platform and the three - dimensional structure data are further researched for further study of the hepatic portal vein shunt . 5 . Using virtual endoscopy technology , the virtual endoscopy and observation of the interventional catheter in the hepatic vein were completed on the three - dimensional visualization platform of the portal vein shunt pathway in the hepatic portal vein . 6 . On the graphic workstation , the virtual puncture of portal vein shunt and portal vein shunt through the portal vein in the hepatic vein to the intrahepatic portal vein were simulated . The path and procedure of vein puncture were demonstrated , which laid the foundation for the establishment of a simulated training system for hepatic vascular interventional procedure . 7 . On the basis of three - dimensional visualization model , the puncture path and the puncture approach of the interventional catheter of the hepatic portal vein were designed based on the characteristics of the hepatic vein , compared the characteristics of the transjugular approach and the DIPS path puncture approach , and provided a preliminary computer model for preoperative planning and the establishment of a reasonable personalized interventional procedure .

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2007
【分類(lèi)號(hào)】：R322;R657.3

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 孫俊旗;磁共振肝臟三維模型及虛擬肝切除在肝臟外科計(jì)劃的應(yīng)用[D];汕頭大學(xué);2010年

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本文編號(hào)：1439131