Fang Chi-Hua, Huang Yan-Peng, Lu Chao-Min, Li Xiao-Feng, Chen Zhi-Xiang, Su Zhong-He, Qiu Wen-Feng
Department of Hepatobiliary Surgery, Zhujiang Hospital Affiliated to Southern Medical University, Guangzhou, China.
Zhonghua Wai Ke Za Zhi. 2009 Jun 15;47(12):909-11.
To study the value of digital medical technology in diagnosis and treatment of the hepatolithiasis.
64-slice spiral computer tomography (CT) scan data of 14 cases (11 female, 3 male; median age, 48 years) with hepatolithiasis admitted from February to September 2008 were collected. The data were imported into medical image proceeding system (MIPS) for sequence segmenting and three-dimensional (3D) reconstruction. The reconstructed models were imported into FreeForm Modeling System for performing simulation surgery with simulation surgical instruments. According to the results of 3D reconstruction and simulation surgery, reasonable operation strategies were chosen. Finally, the value of clinical application of simulation surgery was evaluated according to the findings of clinical operation on hepatolithiasis patients and postoperative T-tube angiography.
The 3D reconstructed models of 14 cases with hepatolithiasis revealed 7 cases of left liver hepatolithiasis, 2 cases of right liver hepatolithiasis, 5 cases of bilateral hepatolithiasis, including 6 cases of hepatolithiasis with common bile duct calculi, 6 cases of biliary system models with absolute stricture, 8 cases with relative stricture. The results were of agreement with clinical diagnosis. A variety of operation plans were simulated before operation. Simulation equipment used in process of simulation surgery was a powerful sense of feedback.
Digital medical technology is helpful to understand the calculi distribution, bile ducts stricture and deformity. Through preoperative training, simulation surgery are able to guide for choosing operative strategies. It reduces the operation risks.
探讨数字医学技术在肝内胆管结石诊治中的应用价值。
收集2008年2月至9月收治的14例肝内胆管结石患者（女11例，男3例；年龄中位数48岁）的64层螺旋计算机断层扫描（CT）数据。将数据导入医学图像后处理系统（MIPS）进行序列分割及三维（3D）重建。将重建模型导入FreeForm建模系统，使用模拟手术器械进行模拟手术。根据3D重建及模拟手术结果选择合理的手术策略。最后，根据肝内胆管结石患者临床手术及术后T管造影结果评估模拟手术的临床应用价值。
14例肝内胆管结石患者的3D重建模型显示，左肝内胆管结石7例，右肝内胆管结石2例，双侧肝内胆管结石5例，其中合并胆总管结石6例，胆道系统模型绝对狭窄6例，相对狭窄8例。结果与临床诊断相符。术前模拟了多种手术方案。模拟手术过程中使用的模拟设备反馈感强烈。
数字医学技术有助于了解结石分布、胆管狭窄及畸形情况。通过术前训练，模拟手术能够指导手术策略的选择，降低手术风险。
