胸外科术前模拟的三维图像重建进展
Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery.
作者信息
Chen-Yoshikawa Toyofumi F, Date Hiroshi
机构信息
Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
出版信息
J Thorac Dis. 2016 Mar;8(Suppl 3):S295-301. doi: 10.3978/j.issn.2072-1439.2016.02.39.
BACKGROUND
Three-dimensional computed tomography (3D-CT) technologies have been developed and refined over time. Recently, high-speed and high-quality 3D-CT technologies have also been introduced to the field of thoracic surgery. The purpose of this manuscript is to demonstrate several examples of these 3D-CT technologies in various scenarios in thoracic surgery.
METHODS
A newly-developed high-speed and high-quality 3D image analysis software system was used in Kyoto University Hospital. Simulation and/or navigation were performed using this 3D-CT technology in various thoracic surgeries.
RESULTS
Preoperative 3D-CT simulation was performed in most patients undergoing video-assisted thoracoscopic surgery (VATS). Anatomical variation was frequently detected preoperatively, which was useful in performing VATS procedures when using only a monitor for vision. In sublobar resection, 3D-CT simulation was more helpful. In small lung lesions, which were supposedly neither visible nor palpable, preoperative marking of the lesions was performed using 3D-CT simulation, and wedge resection or segmentectomy was successfully performed with confidence. This technique also enabled virtual-reality endobronchial ultrasonography (EBUS), which made the procedure more safe and reliable. Furthermore, in living-donor lobar lung transplantation (LDLLT), surgical procedures for donor lobectomy were simulated preoperatively by 3D-CT angiography, which also affected surgical procedures for recipient surgery. New surgical techniques such as right and left inverted LDLLT were also established using 3D models created with this technique.
CONCLUSIONS
After the introduction of 3D-CT technology to the field of thoracic surgery, preoperative simulation has been developed for various thoracic procedures. In the near future, this technique will become more common in thoracic surgery, and frequent use by thoracic surgeons will be seen in worldwide daily practice.
背景
随着时间的推移，三维计算机断层扫描（3D-CT）技术不断发展和完善。最近，高速、高质量的3D-CT技术也已引入胸外科领域。本文旨在展示这些3D-CT技术在胸外科各种场景中的几个应用实例。
方法
京都大学医院使用了新开发的高速、高质量3D图像分析软件系统。在各种胸外科手术中使用该3D-CT技术进行模拟和/或导航。
结果
大多数接受电视辅助胸腔镜手术（VATS）的患者进行了术前3D-CT模拟。术前经常检测到解剖变异，这在仅使用监视器进行视觉观察的VATS手术中很有用。在亚肺叶切除术中，3D-CT模拟更有帮助。在据推测既不可见也不可触及的小肺病变中，使用3D-CT模拟进行病变的术前标记，并成功自信地进行了楔形切除或肺段切除术。该技术还实现了虚拟现实支气管内超声检查（EBUS），使手术更加安全可靠。此外，在活体供肺叶移植（LDLLT）中，术前通过3D-CT血管造影模拟供肺叶切除的手术过程，这也影响了受体手术的手术过程。还使用该技术创建的3D模型建立了诸如左右倒置LDLLT等新的手术技术。
结论
3D-CT技术引入胸外科领域后，已针对各种胸外科手术开展了术前模拟。在不久的将来，该技术在胸外科将变得更加普遍，胸外科医生在全球日常实践中的频繁使用也将可见。
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