CN110547870A - Accurate liver operation navigation positioning device - Google Patents
Accurate liver operation navigation positioning device Download PDFInfo
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- CN110547870A CN110547870A CN201910706884.5A CN201910706884A CN110547870A CN 110547870 A CN110547870 A CN 110547870A CN 201910706884 A CN201910706884 A CN 201910706884A CN 110547870 A CN110547870 A CN 110547870A
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- 210000004185 liver Anatomy 0.000 title claims abstract description 199
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- 238000007789 sealing Methods 0.000 claims description 70
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- 238000009826 distribution Methods 0.000 claims description 8
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/101—Computer-aided simulation of surgical operations
- A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2068—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis using pointers, e.g. pointers having reference marks for determining coordinates of body points
Abstract
The invention provides an accurate liver surgery navigation positioning device which mainly comprises a diaphragm navigation module, a visceral navigation module and a focus navigation module, wherein the generated modules are used for marking all sections on the surface of a liver and focus boundary lines. The operation navigation positioning module of the invention provides a visual and clear liver surface boundary line for a liver surgery doctor, thereby carrying out the anatomical resection of a specific liver segment, reducing the operation complication and simultaneously improving the prognosis of the surgical resection of a liver tumor patient. The invention integrates the advantages of a plurality of disciplines and aims to solve the problem of accurate liver resection operation. Through the construction of the digital three-dimensional liver, the intelligent segmentation of the liver, the acquisition of the three-dimensional projection of the surface boundary and the focus and the design and manufacture of the navigation and positioning module of the liver focus, an operator can easily and easily identify the surface boundary of the liver to be cut.
Description
Technical Field
The invention belongs to the field of medical instruments, and relates to a precise liver surgery navigation and positioning device. Through the operation navigation positioning module, the boundary line of liver segmentation and focus can be accurately marked in the liver surgical operation, so that the accurate liver operation is realized.
background
Liver surgery, a complex surgical technique, requires the surgeon to have a very deep and detailed understanding of the anatomical and pathological features of the liver. Currently, in the treatment of liver cancer, surgery is the only possible treatment to cure liver cancer, and among them, precise liver segment resection is more advantageous than tumor local resection. The advantages of accurate liver resection are: obviously reduces the recurrence rate of the postoperative liver cancer and can improve the survival rate of the postoperative patients of the liver cancer. However, previous attempts at precise liver resection have not achieved great success or breakthrough due to limitations of current techniques. In recent years, people can reproduce the structure of the liver by individually scanning and reconstructing a virtual liver image through CT and applying a 3D printing technology to plan the liver operation. However, the problems of real-time navigation and accurate liver section resection in the operation are not well solved by adopting the method at present. In order to solve the above problems, it is necessary to develop a completely new liver surgery navigation system (device).
Disclosure of Invention
The invention aims to provide an accurate liver surgery navigation and positioning device which is composed of a diaphragm navigation module 1, a visceral navigation module 2 and a focus navigation module 3.
The periphery of the diaphragm navigation module 1 is provided with a diaphragm sealing strip 1-1, the middle of the diaphragm navigation module 1 is hollowed, a navigation module inner sealing strip 1-2 is arranged, and the surface of the diaphragm navigation module 1 is provided with a diaphragm navigation module groove 1-3 and a circular hole 1-4.
A dirty surface sealing strip 2-1 is arranged on the periphery of the dirty surface navigation module 2, a dirty surface navigation module groove 2-2 is arranged on the surface of the dirty surface navigation module 2, and a circular hole (not shown in the figure) identical to that of the diaphragm surface navigation module 1 is also arranged.
The focus navigation module 3 is provided with focus closing strips 3-1 at the periphery, wherein the focus navigation module can be provided with a plurality of focus closing strips according to the actual situation. In addition, in some specific cases, some lesion navigation modules combine a lesion navigation module with a visceral plane navigation module due to their closer distance to the visceral plane navigation module.
The focus navigation module 3 is matched with the middle hollow part of the diaphragm navigation module 1. The focus navigation module 3 can be matched with the hollow part in the middle of the visceral surface navigation module 2 according to the requirement.
All modules are connected through sealing strips, wherein a diaphragm surface sealing strip 1-1 is connected with a dirty surface sealing strip 2-1, and a focus surrounding sealing strip 3-1 is connected with a diaphragm surface inner sealing strip 1-2.
The distribution of the grooves 1-3 of the diaphragm navigation module and the grooves 2-2 of the visceral navigation module are marked and set according to the specific anatomical segmentation of the liver surface, so that the boundary of the liver segmentation can be accurately marked.
The circular holes 1-4 are uniformly distributed, so that the attachment degree of the module and the surface of the liver can be observed, the module can be better attached to the surface of the liver, and the accuracy of navigation and positioning can be improved.
Each sealing strip is provided with a concave-convex matched mortise-tenon structure, and the grooves and the bulges on the two connecting sealing strips are matched with each other to complete tight connection. Wherein the diaphragm surface sealing strip 1-1 is provided with a diaphragm surface groove 1-1-1 and a diaphragm surface bulge 1-1-2, the dirty surface sealing strip 2-1 is provided with a dirty surface bulge 2-1-1 and a dirty surface groove 2-1-2, and similarly, the focus sealing strip 3-1 is provided with a groove and a bulge (not shown in the figure). Through the accurate coincidence of the corresponding groove and the corresponding bulge on the sealing strip, the diaphragm navigation module 1 and the dirty navigation module 2 are closed into a whole. Similarly, the focus navigation module 3 and the diaphragm navigation module 1 are also combined through a concave-convex matched mortise and tenon structure of the sealing strip.
After the navigation module is used, a thin metal sheet is inserted into a gap between the upper sealing strip and the lower sealing strip, and the sealing strips are rotated and opened until the tenon-mortise joint is matched and the mortise-tenon joint is disconnected.
The invention provides a brand-new accurate liver surgery navigation positioning device based on liver surgery navigation positioning by comprehensively applying medical images, computer three-dimensional imaging, medical engineering, 3D printing, surgical operations and other multi-subject technologies. The design principle of the invention is to construct a digital three-dimensional liver according to the imaging, and then generate and mark boundary lines of various liver segments and the area of a focus according to the internal structure of the liver, including the distribution of hepatic artery, portal vein and hepatic duct structures and the stereo anatomical structure of the focus (if any). Wherein, the focus area is vertically projected to the liver surface with the shortest distance. The classical Couinaud method is adopted for the anatomical segmentation of the liver, and the liver is divided into 8 segments based on each perfusion region of each region of the portal vein system (left half liver, right anterior lobe and right posterior lobe) and the hepatic vein (left hepatic, middle hepatic and right hepatic veins).
In order to generate the navigation positioning module, the three-dimensional data of the liver surface is extracted, wherein the three-dimensional data comprises the liver segment boundary and the three-dimensional projection area of the focus. Due to the fact that imaging of the imaging optics has a certain thickness, the extracted three-dimensional data of the surface of the liver has rugged noise. And smoothing the noise by using a Gaussian algorithm to ensure that the extracted liver surface is basically consistent with the real liver surface. The three-dimensional data of the liver surface is generated into a format capable of three-dimensional display, namely a so-called digital liver surface module. Generally, according to the face of the liver, the liver surface module is divided into a diaphragm face and a visceral face. The diaphragm surface and the visceral surface, which can be simply understood as the upper surface and the lower surface of the liver, are finally printed and molded by using a 3D printing technology.
The invention designs a navigation device in the liver surgery process, and a generated module is used for marking each section of the liver surface and a lesion boundary line. The method comprises the steps of obtaining imaging data of liver image scanning, constructing a digital three-dimensional liver according to the imaging data, dividing the three-dimensional structure of each liver segment and each focus on the digital liver according to the distribution of pipelines and focuses in the liver, extracting the three-dimensional data of boundary lines of the liver segments and the focuses, designing and generating a digital liver navigation module, and directly distinguishing and marking the surface boundary lines of the liver segments and the focuses in the liver surgery process through a 3D printing liver navigation positioning module. The operation navigation positioning module of the invention provides a visual and clear liver surface boundary line for liver surgery doctors, thereby carrying out anatomical resection of specific liver segments, reducing operation complications and improving the prognosis of surgical resection of liver tumor patients. The invention integrates the advantages of a plurality of disciplines and aims to solve the problem of accurate liver resection operation. Through the construction of the digital three-dimensional liver, the intelligent segmentation of the liver, the acquisition of the three-dimensional projection of the surface boundary and the focus and the design and manufacture of the navigation and positioning module of the liver focus, an operator can easily and easily identify the surface boundary of the liver to be cut.
drawings
fig. 1 illustrates a top view of a diaphragm face navigation module, a visceral face navigation module, and a lesion navigation module.
Fig. 2 shows a schematic closing view of the mortise and tenon joint structure between the modules through the closing strip.
Fig. 3 shows a schematic diagram of the manufacturing of the liver surgery navigation system of the present invention.
Fig. 4 shows a flow chart of the implementation of the liver surgery navigation and positioning module.
Fig. 5 shows an implementation schematic diagram of the liver surgery navigation and positioning module in the embodiment 4.
Fig. 6 shows an implementation schematic diagram of the liver surgery navigation and positioning module in the embodiment 5.
Fig. 7 shows an implementation schematic diagram of the liver surgery navigation and positioning module in the embodiment 6.
Detailed Description
In order to make the specific application and implementation process of the present invention clearer, the following will clearly and completely describe the technical solution of the present invention with reference to the drawings and the embodiments of the present invention. The described embodiments are some of the embodiments of the present invention, including but not limited to those described.
Example 1
Referring to fig. 1 and 2, the navigation and positioning device for liver surgery is composed of a diaphragm navigation module 1, a visceral navigation module 2 and a lesion navigation module 3. Because the liver is a three-dimensional structure, the diaphragm surface is the upper surface of the liver, and the visceral surface is the lower surface of the liver.
The periphery of the diaphragm navigation module 1 is provided with diaphragm sealing strips 1-1, the middle of the diaphragm navigation module 1 is hollowed, diaphragm inner sealing strips 1-2 are arranged, and the surface of the diaphragm navigation module 1 is provided with diaphragm navigation module grooves 1-3 and circular holes 1-4.
a dirty surface sealing strip 2-1 is arranged on the periphery of the dirty surface navigation module 2, a dirty surface navigation module groove 2-2 is arranged on the surface of the dirty surface navigation module 2, and a circular hole (not shown in the figure) identical to that of the diaphragm surface navigation module 1 is also arranged.
The focus navigation module 3 is provided with focus closing strips 3-1 at the periphery, wherein the focus navigation module 3 can be provided with a plurality of focus closing strips according to the actual situation. In some particular cases, some lesion navigation modules combine a lesion navigation module with a visceral plane navigation module due to their closer distance to the visceral plane navigation module.
The focus navigation module 3 in fig. 1 is matched with a hollow part in the middle of the diaphragm navigation module 1, and all modules are connected through a sealing strip, wherein the diaphragm sealing strip 1-1 is connected with the dirty sealing strip 2-1, and the focus sealing strip 3-1 is connected with the diaphragm inner sealing strip 1-2.
The distribution of the grooves 1-3 of the diaphragm navigation module and the grooves 2-2 of the visceral navigation module are marked and set according to the specific anatomical segmentation of the liver surface, the liver segmentation is divided according to the classical Couinaud method based on the perfusion areas of the portal vein and the hepatic vein, and the dividing line of the liver segmentation can be accurately marked in the operation process through the groove structure of the navigation module.
The surfaces of the navigation modules are provided with circular holes which are uniformly distributed, such as the circular holes 1-4 in the diaphragm navigation module shown in figure 1, and the circular holes in the dirty navigation module and the focus navigation module are similarly arranged according to the principle. So set up the circular port and be favorable to observing the laminating degree on module and liver surface to do benefit to the better laminating of module in the liver surface, thereby improve the accuracy nature of navigation location.
Referring to fig. 2, each sealing strip is provided with a concave-convex matched mortise-tenon structure, namely each sealing strip is provided with a groove and a bulge, when the diaphragm navigation module 1 is connected with the dirty navigation module 2, the diaphragm groove 1-1-1 and the diaphragm protrusion 1-1-2 on the diaphragm sealing strip 1-1 are matched with the dirty groove 2-1-2 and the dirty protrusion 2-1-1 on the dirty navigation module sealing strip 2-1, thereby completing the closing or the separation of the modules, similarly, when the focus navigation module 3 is connected with the diaphragm navigation module 1 in a hollow way, the groove and the protrusion on the focus closing strip 3-1 of the focus navigation module 3 are matched with the groove and the protrusion on the closing strip 1-2 in the diaphragm (not shown in the figure), so that the closing or the separation between the focus navigation module 3 and the diaphragm navigation module 1 is completed.
The bulges and the grooves of the concave-convex matched tenon-and-mortise structure are different in size, for example, the diaphragm surface groove 1-1-1 is a small matched tenon-and-mortise groove, the dirty surface groove 2-1-2 is a large matched tenon-and-mortise groove, the diaphragm surface bulge 1-1-2 is a large matched tenon-and-mortise bulge, and the dirty surface bulge 2-1-1 is a small matched tenon-and-mortise bulge, so that the matching between the sealing strips is more complete and tight through the grooves and the bulges with different sizes, and unnecessary dislocation matching is prevented to a certain extent. The navigation module is separated in a way that a thin metal sheet is inserted into a gap between the upper and lower sealing strips, and the sealing strips are rotated and opened until the concave-convex anastomosis mortise-tenon joint is released. Thereby separating the connections between the various modules.
Example 2
Referring to fig. 3, the device of the present invention is prepared by the following steps:
1. Acquiring image information: the CT image is obtained as a DICOM standard image by thin layer CT examination of the liver before operation of a patient, and the images of each time phase of a plain scan period, an artery period, a portal vein period and a hepatic vein period are selected.
2. Constructing a digital three-dimensional liver: the constructed reconstructed three-dimensional liver comprises internal structures of the liver, including structures of hepatic artery, portal vein, hepatic vein, inferior vena cava, hepatic duct, biliary tract, gall bladder, focus and perihepatic ligament. Firstly, marking the outline of the liver in a thin layer enhanced CT image of the liver so as to basically determine the reconstruction range of the digital three-dimensional liver, wherein the outline comprises marks of a gallbladder, a common bile duct and a common hepatic duct; secondly, marking strengthened and developed small branches of abdominal aorta, abdominal trunk artery, hepatic common artery, hepatic inherent artery, left hepatic artery, right hepatic artery and intrahepatic artery in the hepatic artery phase CT image; thirdly, marking a portal vein trunk, a portal vein left branch, a portal vein right branch, a portal vein sagittal part, a portal vein right anterior branch, a portal vein right posterior branch and other portal vein small branches which are subjected to enhanced visualization in a portal vein period CT image; fourthly, marking the right hepatic vein, the middle hepatic vein, the left hepatic vein and the inferior vena cava in a hepatic vein phase CT image, fifth, further marking the running of an intrahepatic bile duct if the intrahepatic bile duct is expanded, simultaneously marking perihepatic ligament structures such as ligamentum teres hepatis and the like, and sixth, marking the outline of an intrahepatic lesion, and simultaneously marking the residual structures (except the marked structures) in the outline range of the liver to be the normal liver tissue range. And converting the two-dimensional graph into a three-dimensional image by using a Gaussian algorithm, thereby constructing the digital three-dimensional liver.
3. Liver segmentation: dividing the boundary of each hepatic segment according to the distribution of the portal vein, the branches of the hepatic vein and the branches, and marking each hepatic segment on the surface of the digital three-dimensional liver. And a lesion boundary; the boundary between each section of the liver and the boundary of the two-dimensional projection contour of the focus to the nearest liver surface.
4. Demarcation of focus: the liver lesion is projected to the nearest liver surface, thereby presenting the contour boundary of the lesion on the digital three-dimensional liver surface. Sometimes the focus is close to the hepatic diaphragm surface, sometimes the focus is close to the hepatic surface, according to the specific situation, the focus is projected to the corresponding liver surface.
5. Extracting the three-dimensional data of the liver surface, wherein the three-dimensional data comprises segmentation and lesion boundary information of the liver.
6. And performing artificial noise reduction processing on the extracted data to smooth the surface of the digital liver. The smaller the thickness between each layer of the thin-layer CT is, the smaller the intervention of manual noise reduction processing is required, and meanwhile, the three-dimensional image is closer to the situation of a real liver.
7. And (3) manufacturing each module: editing the three-dimensional liver surface data extracted in the above steps, wherein the main contents of editing are as follows. Firstly, endowing the surface of the liver with certain thickness (5 mm); secondly, the surface of the liver is filled with evenly distributed circular holes; thirdly, a certain width (5mm) is given to the dividing line of the liver segment; fourthly, extracting the focus projection on the surface part of the liver, and generating a diaphragm navigation module, a visceral navigation module and a focus navigation module basically; fifthly, the sealing strip is arranged around the diaphragm navigation module, the visceral surface navigation module and the focus navigation module.
8. And generating a file suitable for a 3D printing format by the navigation module, and finishing the manufacture of the navigation module after 3D. The navigation module is suitable for intraoperative navigation positioning of most cases, but needs to be adjusted correspondingly according to actual conditions in the specific implementation process. The content of the adjustment comprises: the number of the focus navigation modules, the position of the focus navigation module and the groove distribution in the navigation module.
Example 3
The evaluation project before the liver surgery patient comprises the examination of liver CT. DICOM standard image information for each phase of thin-layer liver-enhanced CT is obtained by following the procedure in example 3 for subsequent reconstruction of three-dimensional digital liver by open source software (3D slicer, https:// www.slicer.org /). In the implementation process, the thin-layer liver CT is selected to perform three-dimensional reconstruction so as to more accurately simulate the state of a real liver (the common liver CT is 5mm in thickness, and the thin-layer liver CT is generally 1mm in thickness). In addition, structures inside the liver, such as hepatic artery, hepatic duct, portal vein, hepatic vein, lesion, etc., are marked by means of artificial marking, and tissue structures extending outside the liver, such as inferior vena cava, common bile duct, gallbladder, etc., are also marked.
The above marking is performed for the purpose of further three-dimensional digital segmentation of the liver and projection of the lesion on the surface of the liver. The three-dimensional digital liver segmentation processing is completely carried out according to the distribution structure of portal veins and hepatic veins in the liver.
After the segmentation of the three-dimensional digital liver and the projection of the focus on the surface of the liver are completed, extracting the data information of the surface of the liver. Smoothing the digital liver envelope by editing the surface structure, thereby eliminating jagged noise and accurately simulating the state of a real liver, wherein the editing is realized by software (zbrush 2018, Pixologic, https:// Pixologic.
And 3D printing the generated digital versions of the liver segment navigation and positioning module and the liver focus navigation and positioning module (shown in figure 1) by using medical photosensitive resin.
Fig. 1 is a structural diagram generated by further software editing of a liver segment navigation and positioning module and a liver lesion navigation and positioning module, wherein 1 is a diaphragm navigation module, 2 is a visceral navigation module, and 3 is a lesion navigation module. Because the focus of the case in fig. 1 is closer to the diaphragm module, the focus navigation module is arranged to be matched with the hollow part in the middle of the diaphragm navigation module. As shown in fig. 2, the sealing strip of each module is provided with a concave-convex matched tenon-and-mortise structure (fig. 2A), the diaphragm sealing strip 1-1 and the dirty sealing strip 2-1 are concave-convex matched (fig. 2B), and the reason for the separate arrangement is that each navigation module can be assembled or disassembled, so that each navigation module can be conveniently adjusted as required in the operation process. The structural arrangement of the diaphragm surface groove 1-3 is used for outlining the liver diaphragm surface subsection, and the structural arrangement of the visceral surface groove 2-2 is used for outlining the liver visceral surface subsection. The circular holes 1-4 which are uniformly arranged are distributed in the middle of each module and are in a hollow state (the general diameter is 5mm and can be adjusted according to the size of the module), the reason for the arrangement is that the use of materials is reduced as much as possible on the premise of not reducing the strength of the three-dimensional structure, and the condition that the module is attached to the liver can be observed conveniently.
Each navigation module sealing strip is provided with a concave-convex matched tenon-and-mortise structure, so that the matching between the connected module sealing strips can be more complete and tight, unnecessary dislocation matching is prevented to a certain extent, and each navigation module can be combined or disassembled according to the requirement.
Example 4
In the process of practically applying the navigation and positioning module, basically, according to the figure 4, the diaphragm face and the visceral face navigation and positioning module are firstly attached to the surface of the liver, and then the concave-convex anastomosis mortise-tenon joint is closed by finger pressurization, so that the closed diaphragm face and visceral face module are fixedly attached to the surface of the liver without the attachment degree of the closed diaphragm face and visceral face module being influenced by external force. Then, the focus navigation positioning module and the liver segment navigation positioning module are combined through a similar concave-convex matched mortise-tenon structure.
Marking the boundary line of the liver section to be excised on the surface of the liver by using an intraoperative electrocoagulation device, removing the liver lesion navigation and positioning module from the diaphragm positioning module by using forceps or vascular forceps, and marking the boundary line of the lesion on the surface of the liver by using the electrocoagulation device. Finally, a thin metal sheet is inserted into a gap between the upper sealing strip and the lower sealing strip, the sealing strips are rotated and opened until the concave-convex anastomosis mortise-tenon joint is released, all the liver navigation and positioning modules are taken down, and further surgical resection of liver segments can be implemented.
Fig. 5 is an implementation schematic diagram of the liver surgery navigation and positioning module in a surgery process, wherein a shows that the diaphragm navigation module 1 and the visceral surface navigation module 2 are attached to the liver 4, and the sealing strips at the upper and lower edges are pressed hard to close the concave-convex mortise-tenon structure inside the sealing strips. B shows the lesion navigation module 3 closed to the diaphragmatic navigation module 2. And C, a sagittal section view of the navigation module closed on the liver, wherein each navigation module is tightly attached to the surface of the liver. After the navigation module is used, a thin metal sheet is inserted into a gap between the upper sealing strip and the lower sealing strip, and the sealing strips are rotated and opened until the tenon-mortise joint is matched and the mortise-tenon joint is disconnected.
Example 5
When the position and the size of the focus of the liver are changed, the position and the size of the focus navigation module are changed accordingly. As shown in fig. 6, when the lesion is close to the liver surface, the lesion navigation module 7 is disposed in the visceral surface navigation module 6. D, the diaphragm navigation module 5 and the visceral surface navigation module 6 are attached to the liver 8, and meanwhile, the sealing strips on the upper edge and the lower edge are pressed forcefully to close the concave-convex mortise-tenon structure inside the sealing strips. E shows closing the lesion navigation module 7 to the visceral surface navigation module 6. And F is a sagittal section view of the navigation module closed on the liver, and each navigation module is tightly attached to the surface of the liver. After the navigation module is used, a thin metal sheet is inserted into a gap between the upper sealing strip and the lower sealing strip, and the sealing strips are rotated and opened until the tenon-mortise joint is matched and the mortise-tenon joint is disconnected.
example 6
When there are multiple focuses of the liver, especially when the multiple focuses are distributed on the diaphragm surface and the visceral surface of the liver, the positions of the focus navigation modules need to be set in the diaphragm surface navigation module and the visceral surface navigation module respectively. When the two lesions are located on the liver diaphragm surface and the liver surface, respectively, as shown in fig. 7, the first lesion navigation module 11 and the second lesion navigation module 12 are respectively engaged with the diaphragm navigation module 9 and the liver navigation module 10. G shows that the diaphragm navigation module 9 and the visceral surface navigation module 10 are attached to the liver 13, and meanwhile, the sealing strips on the upper edge and the lower edge are pressed forcefully to close the concave-convex mortise-tenon structure inside the sealing strips. H shows that the first lesion navigation module 11 is closed to the diaphragm navigation module 9, I shows that the second lesion navigation module 12 is closed to the diaphragm navigation module 10, J shows a sagittal section view of the liver with the navigation modules closed, and each navigation module is tightly attached to the surface of the liver. After the navigation module is used, a thin metal sheet is inserted into a gap between the upper sealing strip and the lower sealing strip, and the sealing strips are rotated and opened until the tenon-mortise joint is matched and the mortise-tenon joint is disconnected.
According to the navigation positioning module for the liver surgery, which is generated by the invention, the surface is in a small round hole uniform hollow design, so that the observation of the fitting degree in the implementation process is facilitated; the groove design is favorable for marking the division of the liver segment in the operation, and the completely closed connection of the module periphery and the groove is favorable for maintaining the three-dimensional shape. In addition, the liver lesion navigation and positioning module in this embodiment is a single module close to the diaphragm surface, and if there are multiple lesions or close to the visceral surface in a specific case, the corresponding number and position may be set according to the actual situation. With focus navigation module and diaphragm face/dirty face navigation module can dismantle through the tenon fourth of the twelve earthly branches structure that coincide, have following advantage: when the diameter of the focus is too large, and the liver navigation and positioning module is attached to the surface of the liver, too large errors are generated, so that the accurate navigation and positioning of the liver is influenced. At the moment, the liver focus navigation and positioning module and the liver segment navigation and positioning module are combined for use, so that errors caused by incomplete fitting can be reduced as much as possible. When the position of the liver tumor needs to be marked, the liver focus navigation and positioning module can be detached, so that intraoperative marking is facilitated. The use design of the combination and the disassembly is beneficial to the smooth operation and navigation.
Claims (9)
1. The utility model provides an accurate liver operation navigation positioning device, a serial communication port, this positioner comprises diaphragm face navigation module (1), dirty face navigation module (2) and focus navigation module (3) three module, diaphragm face navigation module (1) periphery is equipped with diaphragm face seal strip (1-1), fretwork in the middle of diaphragm face navigation module (1), be equipped with diaphragm face internal seal strip (1-2), be equipped with diaphragm face navigation module slot (1-3) and circular port (1-4) on diaphragm face navigation module (1) surface, dirty face navigation module (2) periphery is equipped with dirty face seal strip (2-1), be equipped with dirty face navigation module slot (2-2) and circular port on dirty face navigation module (2) surface, focus navigation module (3) are equipped with focus seal strip (3-1).
2. The accurate liver surgery navigation and positioning device according to claim 1, wherein the modules are connected through sealing strips, a diaphragm surface sealing strip (1-1) is connected with a visceral surface sealing strip (2-1), and a lesion sealing strip (3-1) is connected with a diaphragm surface inner sealing strip (1-2).
3. The accurate liver surgery navigation and positioning device as claimed in claim 1, wherein each sealing strip is provided with a concave-convex matched tenon-and-mortise structure with a groove and a protrusion, and the grooves and the protrusions on the two connecting sealing strips are matched with each other.
4. The accurate liver surgery navigation and positioning device according to claim 3, wherein the diaphragm face sealing strip (1-1) is provided with a diaphragm face groove (1-1-1) and a diaphragm face protrusion (1-1-2), the visceral face navigation module sealing strip (2-1) is provided with a visceral face groove (2-1-2) and a visceral face protrusion (2-1-1), and similarly, the lesion sealing strip (3-1) is provided with a groove and a protrusion.
5. The accurate liver surgery navigation and positioning device according to claim 4, wherein when the diaphragm navigation module (1) is connected with the visceral surface navigation module (2), the diaphragm groove (1-1-1) is fitted with the visceral surface protrusion (2-1-1), the diaphragm protrusion groove (1-1-2) is fitted with the visceral surface groove (2-1-2), and when the focus navigation module (3) is connected with the diaphragm navigation module (1), the focus sealing strip (3-1) is provided with a groove and a protrusion which are fitted with a groove and a protrusion on the diaphragm inner sealing strip (1-2).
6. The accurate liver surgery navigation and positioning device according to claim 1, wherein a plurality of lesion navigation modules (3) are arranged according to actual conditions.
7. The accurate liver surgery navigation and positioning device according to claim 1, wherein the lesion navigation module (3) is combined with a diaphragm navigation module (1) or a visceral navigation module (2).
8. The accurate liver surgery navigation and positioning device according to claim 1, wherein the lesion navigation module (3) is combined with a hollow part in the middle of the diaphragm navigation module (1).
9. the preparation method of the accurate liver surgery navigation and positioning device of claim 1 is realized by the following steps:
(1) acquiring image information: selecting images of each time phase of a plain scan period, an artery period, a portal vein period and a hepatic vein period, and acquiring a CT image as a DICOM standard image;
(2) Constructing a digital three-dimensional liver: according to the fact that the CT image is a DICOM standard image, a two-dimensional graph is converted into a three-dimensional image through a Gaussian algorithm, and therefore a three-dimensional liver is constructed and comprises an internal structure of the liver: hepatic artery, portal vein, hepatic vein, inferior vena cava, hepatic duct, biliary tract, gallbladder, focus and perihepatic ligament;
(3) Liver segmentation: dividing boundary lines of all liver segments according to the distribution of branches and branches of portal veins and hepatic veins, and marking all liver segments on the surface of the digital three-dimensional liver; and a focus boundary;
(4) Demarcation of focus: projecting the liver focus on the surface of the liver closest to the liver, so that the outline boundary of the focus is presented on the digital three-dimensional liver surface, sometimes the focus is closer to the hepatic diaphragm surface, sometimes the focus is closer to the hepatic organ surface, and the focus is projected to the corresponding liver surface according to specific conditions;
(5) Extracting three-dimensional data of the liver surface, wherein the three-dimensional data comprises segmentation and lesion boundary information of the liver;
(6) Performing artificial noise reduction processing on the extracted data to enable the surface of the digital liver to be smooth;
(7) And (3) manufacturing each module: editing the three-dimensional liver surface data extracted in the steps, wherein the main editing contents are as follows: firstly, endowing the liver surface with a certain thickness, secondly, filling the liver surface with uniformly distributed circular holes, thirdly, endowing the liver with a certain width of a segmented boundary line, fourthly, extracting a focus projection on the liver surface part, and then basically generating a diaphragm navigation module, a visceral navigation module and a focus navigation module, and fifthly, arranging a sealing strip on the diaphragm navigation module, the visceral navigation module and the focus navigation module;
(8) And generating a file suitable for a 3D printing format by the navigation module, and finishing the manufacture of the navigation module after 3D.
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