CN110547870B - Accurate liver operation navigation positioning device - Google Patents
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- 210000004185 liver Anatomy 0.000 title claims abstract description 201
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- 238000004519 manufacturing process Methods 0.000 claims abstract description 6
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- 238000001356 surgical procedure Methods 0.000 claims description 17
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- 238000009826 distribution Methods 0.000 claims description 8
- 210000002767 hepatic artery Anatomy 0.000 claims description 8
- 238000010146 3D printing Methods 0.000 claims description 7
- 210000003459 common hepatic duct Anatomy 0.000 claims description 4
- 210000000232 gallbladder Anatomy 0.000 claims description 4
- 210000003041 ligament Anatomy 0.000 claims description 3
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- 210000001631 vena cava inferior Anatomy 0.000 claims description 3
- 210000003445 biliary tract Anatomy 0.000 claims description 2
- 208000014018 liver neoplasm Diseases 0.000 abstract description 7
- 206010019695 Hepatic neoplasm Diseases 0.000 abstract description 3
- 238000004393 prognosis Methods 0.000 abstract description 2
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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
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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
- A61B2034/108—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
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Abstract
The invention provides a precise liver operation navigation positioning device which mainly comprises a diaphragm surface navigation module, a dirty surface navigation module and a focus navigation module, wherein the generated modules are used for marking each section of the liver surface and focus boundary lines. The operation navigation positioning module provides visual and clear liver surface dividing lines for liver surgeons, so that the anatomical excision of specific liver segments can be performed, the operation complications are reduced, and the prognosis of the operation excision of a liver tumor patient is improved. The invention integrates the advantages of a plurality of subjects and aims to solve the difficult problem of accurate liver segment excision operation. Through the construction of the digital three-dimensional liver, the intelligent segmentation of the liver, the acquisition of the surface boundary and the three-dimensional projection of the focus, and the design and the manufacture of the navigation and positioning module of the focus of the liver, the doctor can simply and easily recognize the surface boundary of the liver to be resected.
Description
Technical Field
The invention belongs to the field of medical instruments, and relates to a navigation and positioning device for accurate liver operation. Through the operation navigation positioning module, the boundary line of the liver and liver segment and the focus can be accurately marked in the liver surgery, thereby realizing accurate liver surgery.
Background
Liver surgery, a complex surgical technique, requires a very thorough and careful understanding of the anatomy and pathological features of the liver by the operator. Currently, in the treatment modes of liver cancer, surgery is the only treatment method which can cure the liver cancer, and precise liver segment excision has advantages over tumor local excision. The accurate liver segment excision has the advantages that: obviously reduces the recurrence rate of postoperative liver cancer and can improve the survival rate of postoperative patients of liver cancer. However, previous attempts at precise segmental hepatectomy have not achieved great success and breakthrough due to the current techniques. Recently, though, a person performs personalized CT scanning and re-generates a virtual liver image, and applies 3D printing technology to reproduce the structure of the liver and plan the liver operation. However, the method does not solve the problems of real-time navigation and accurate liver segment excision in the operation well at present. In order to solve the above-mentioned problems, a new liver operation navigation system (device) needs to be developed.
Disclosure of Invention
The invention aims to provide an accurate liver operation navigation positioning device which consists of three modules, namely a diaphragm surface navigation module 1, a dirty surface 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 out, the inner sealing strip 1-2 of the navigation module 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.
The periphery of the dirty surface navigation module 2 is provided with a dirty surface sealing strip 2-1, the surface of the dirty surface navigation module 2 is provided with a dirty surface navigation module groove 2-2, and a circular hole (shown in the figure) which is the same as the diaphragm surface navigation module 1 is also arranged.
The focus navigation module 3 is provided with focus sealing strips 3-1 around, wherein the focus navigation module can be provided with a plurality of focus sealing strips according to actual conditions. In addition, in some specific cases, some lesion navigation modules combine lesion navigation modules with dirty surface navigation modules due to their closer distance from the dirty surface navigation module.
The focus navigation module 3 is matched with the hollow part in the middle of the diaphragm navigation module 1. The focus navigation module 3 can be matched with the middle hollowed-out part of the dirty surface navigation module 2 according to the requirement.
The modules are connected through a sealing strip, wherein the diaphragmatic surface sealing strip 1-1 is connected with the dirty surface sealing strip 2-1, and the sealing strip 3-1 around the focus is connected with the diaphragmatic surface inner sealing strip 1-2.
The distribution of the diaphragm surface navigation module grooves 1-3 and the dirty surface navigation module grooves 2-2 are marked and set according to specific anatomical segments on the liver surface, and the boundary line of the liver segments can be marked accurately.
The circular holes 1-4 are uniformly distributed, so that the degree of fitting between the module and the liver surface is facilitated to be observed, the module is facilitated to be better fitted on the liver surface, and the accuracy of navigation and positioning is improved.
Each sealing strip is provided with a concave-convex jogged mortise-tenon structure, and grooves and protrusions on two sealing strips connected are mutually matched to finish 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). The diaphragm surface navigation module 1 and the dirty surface navigation module 2 are closed into a whole through the accurate anastomosis of the corresponding grooves and the protrusions on the sealing strip. Similarly, the focus navigation module 3 and the diaphragm navigation module 1 are also combined through the concave-convex matched mortise-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 strip is opened in a rotating way until the sealing strip is matched with the tenon-and-mortise joint to be separated.
The invention provides a novel accurate liver operation navigation positioning device based on liver operation navigation positioning by comprehensively applying medical imaging, computer three-dimensional imaging, medical engineering, 3D printing, surgical operation and other multidisciplinary technologies. The design principle of the invention is to construct a digital three-dimensional liver according to imaging, and then to generate and mark the boundary line of each liver segment and the area of the focus according to the internal structure of the liver, including hepatic artery, portal vein, hepatic duct structure distribution and the stereo anatomy structure of the focus (if any). Wherein the focal region is projected perpendicularly to the liver surface at the shortest distance. Whereas anatomical segmentation of the liver employs the classical Couinaud method, the liver is divided into 8 segments based on the respective perfusion regions of the portal system regions (left half liver, right anterior lobe, right posterior lobe) and hepatic veins (left, middle, right hepatic vein).
In order to generate a navigation positioning module, three-dimensional data of the liver surface is extracted, wherein the three-dimensional data comprise the liver segment boundary line and a three-dimensional projection area of a focus. In view of the fact that imaging has a certain thickness, the extracted three-dimensional data of the liver surface have uneven noise points. And smoothing the noise points by using a Gaussian algorithm, so that the extracted liver surface is basically matched with the real liver surface. The three-dimensional data of the liver surface are generated into a three-dimensional displayable format, namely a so-called digitized liver surface module. Liver surface modules are divided into diaphragm surface and dirty surface according to liver surface. The diaphragm surface and the dirty surface can be simply understood as the upper surface and the lower surface of the liver, and finally the diaphragm surface and the dirty surface are printed and molded by using a 3D printing technology.
The invention designs a navigation device in the liver operation process, and the generated module is used for marking each segment of the liver surface and focus boundary line. The method comprises the steps of acquiring 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 focus on the digital liver according to the distribution of pipelines and focuses in the liver, extracting the three-dimensional data of the boundary line of the liver segment and focus, designing and generating a digital liver navigation module, and printing the liver navigation positioning module through 3D (three-dimensional) for directly distinguishing and marking the boundary line of the surface of the liver segment and the focus in the liver operation process. Through the operation navigation positioning module, an intuitive and clear liver surface dividing line is provided for liver surgeons, so that the anatomical excision of a specific liver segment can be performed, the operation complications are reduced, and the prognosis of the operation excision of a liver tumor patient is improved. The invention integrates the advantages of a plurality of subjects and aims to solve the difficult problem of accurate liver segment excision operation. Through the construction of the digital three-dimensional liver, the intelligent segmentation of the liver, the acquisition of the surface boundary and the three-dimensional projection of the focus, and the design and the manufacture of the navigation and positioning module of the focus of the liver, the doctor can simply and easily recognize the surface boundary of the liver to be resected.
Drawings
Fig. 1 shows a top view of a diaphragm navigation module, a dirty surface navigation module, and a lesion navigation module.
Fig. 2 shows a schematic closing of the mortise and tenon structures between the modules by means of closing strips.
Fig. 3 shows a schematic diagram of the liver surgery navigation system of the present invention.
Fig. 4 shows a flow chart of an implementation of the liver surgery navigation positioning module.
Fig. 5 shows a schematic implementation of the liver surgery navigation positioning module of embodiment 4.
Fig. 6 shows a schematic implementation of the liver surgery navigation positioning module of embodiment 5.
Fig. 7 shows a schematic implementation diagram of the liver surgery navigation positioning module of embodiment 6.
Detailed Description
In order to make the specific application and implementation of the present invention more clear, the following description of the technical solution of the present invention will be made clearly and completely with reference to the accompanying drawings and embodiments of the present invention. The described embodiments are part of embodiments of the invention, including but not limited to those described.
Example 1
Referring to fig. 1 and 2, a navigation and positioning device for liver operation is composed of three modules, namely a diaphragm surface navigation module 1, a dirty surface navigation module 2 and a focus navigation module 3. Because the liver is a three-dimensional structure, the diaphragm surface is the upper surface of the liver, and the dirty surface is the lower surface of the liver.
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 out, the diaphragm 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.
The periphery of the dirty surface navigation module 2 is provided with a dirty surface sealing strip 2-1, the surface of the dirty surface navigation module 2 is provided with a dirty surface navigation module groove 2-2, and the dirty surface navigation module is also provided with a circular hole (shown in the figure) which is the same as the diaphragm surface navigation module 1.
The periphery of the focus navigation module 3 is provided with focus sealing strips 3-1, wherein a plurality of focus navigation modules 3 can be arranged according to actual conditions. In some specific cases, certain lesion navigation modules combine a lesion navigation module with a dirty surface navigation module due to a closer distance from the dirty surface navigation module.
The focus navigation module 3 in fig. 1 is matched with the hollowed-out part in the middle of the diaphragm navigation module 1, and the modules are connected through a sealing strip, wherein the diaphragm sealing strip 1-1 is connected with the dirty surface sealing strip 2-1, and the focus sealing strip 3-1 is connected with the intra-diaphragm sealing strip 1-2.
The distribution of the diaphragmatic navigation module grooves 1-3 and the dirty surface navigation module grooves 2-2 are marked and set according to specific anatomical segments on the liver surface, the liver segments are 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 segments can be accurately marked in the operation process through the groove structure of the navigation module.
The surface of each navigation module is provided with evenly distributed circular holes, such as the circular holes shown as 1-4 in the diaphragm navigation module in fig. 1, and the circular holes in the dirty surface navigation module and the focus navigation module are arranged in the same way according to the principle. The circular hole is favorable for observing the fitting degree of the module and the liver surface, so that the module can be better fitted on the liver surface, and the navigation and positioning accuracy is improved.
Referring to fig. 2, each sealing strip is provided with a concave-convex engagement mortise-tenon structure, that is, each sealing strip is provided with a groove and a protrusion, when the diaphragm surface navigation module 1 is connected with the dirty surface navigation module 2, the diaphragm surface groove 1-1-1 and the diaphragm surface protrusion 1-1-2 on the diaphragm surface sealing strip 1-1 are engaged with the dirty surface groove 2-1-2 and the dirty surface protrusion 2-1-1 on the dirty surface navigation module sealing strip 2-1, so that the closing or separating between the modules is completed, and similarly, when the focus navigation module 3 is connected with the middle hollow of the diaphragm surface navigation module 1, the groove and the protrusion on the focus sealing strip 3-1 of the focus navigation module 3 are engaged with the groove and the protrusion on the diaphragm surface inner sealing strip 1-2 (not shown in the figure), so that the closing or separating between the focus navigation module 3 and the diaphragm surface navigation module 1 is completed.
The convex and concave matching mortise structure is provided with different sizes, for example, the concave groove 1-1-1 of the diaphragm surface is a matching mortise small groove, the concave groove 2-1-2 of the dirty surface is a matching mortise large groove, the convex 1-1-2 of the diaphragm surface is a matching mortise large convex, the convex 2-1-1 of the dirty surface is a matching mortise small convex, and the matching between the sealing strips is more complete and tight through the concave grooves and the convex with different sizes, and unnecessary dislocation matching is prevented to a certain extent. The navigation module is separated by inserting a thin metal sheet into a gap between the upper sealing strip and the lower sealing strip, and rotating the sealing strip to open the concave-convex engagement mortise and tenon joint. Thereby separating the connections between the individual modules.
Example 2
Referring to fig. 3, the device of the present invention is prepared by the steps of:
1. Obtaining image information: the CT examination is enhanced by a liver thin layer before the operation of a patient, so that a CT image is obtained as a DICOM standard image, and images of each phase of the flat scanning period, the arterial period, the portal vein period and the hepatic vein period are selected.
2. Construction of digital three-dimensional livers: the reconstructed three-dimensional liver comprises internal liver structures including hepatic artery, portal vein, hepatic vein, inferior vena cava, hepatic duct, biliary tract, gall bladder, focus and perihepatic ligament structures. Firstly, marking the outline of the liver in a liver thin-layer enhanced CT image so as to basically determine the reconstruction range of the digital three-dimensional liver, wherein the reconstruction range comprises marks of a gall bladder, a common bile duct and a common liver duct; secondly, marking small branches of the abdominal aorta, the celiac dry artery, the common hepatic artery, the intrinsic hepatic artery, the left hepatic artery, the right hepatic artery and the intrahepatic artery which strengthen the development in the CT image of the hepatic arterial stage; thirdly, marking a portal vein trunk, a portal vein left branch, a portal vein right branch, a portal vein sagittal portion, a portal vein right front branch, a portal vein right rear branch and other portal vein branches which strengthen development in the portal vein CT image; fourth, in the hepatic vein CT image, the hepatic right vein, the hepatic middle vein, the hepatic left vein and the inferior vena cava are marked, fifth, if the intrahepatic duct is expanded, the intrahepatic duct is further marked, meanwhile, the perihepatic ligament structures such as the hepatic round ligament are marked, sixth, the outline of the intrahepatic focus is marked, and the rest structures (except the marked structures) in the outline range of the liver are 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. Segmentation of liver: dividing the boundary of each liver segment according to the branches and branch distribution of portal vein and hepatic vein, and marking each liver segment on the surface of the digital three-dimensional liver. And a lesion parting line; boundaries between segments of the liver, and two-dimensional projection contour boundaries where the lesion is closest to the liver surface.
4. Demarcation of lesions: the liver lesion is projected on the surface of the liver nearest to the surface of the liver, thereby presenting the contour demarcation of the lesion on the digital three-dimensional liver surface. Sometimes the focus is closer to the liver diaphragm surface, sometimes the focus is closer to the liver surface, and the focus is projected to the corresponding liver surface according to specific conditions.
5. And extracting three-dimensional data of the liver surface, wherein the three-dimensional data comprise segmentation and focus boundary information of the liver.
6. And (3) carrying out manual noise reduction treatment 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 treatment is required, and the three-dimensional image is more similar to the situation of a real liver.
7. And (3) manufacturing each module: and editing the three-dimensional liver surface data extracted in the steps, wherein the main editing content is as follows. Firstly, a certain thickness (5 mm) is given to the liver surface; second, the liver surface is filled with evenly distributed circular holes; thirdly, giving a certain width (5 mm) to the parting line of the liver segment; fourthly, extracting focus projection on the surface part of the liver, and basically generating a diaphragm surface navigation module, a dirty surface navigation module and a focus navigation module; fifthly, the sealing strip is arranged around the diaphragm surface navigation module, the dirty surface navigation module and the focus navigation module.
8. And generating a file applicable to the 3D printing format by the navigation module, and completing the manufacture of the navigation module after 3D printing. The navigation module is suitable for navigation positioning in the operation of most cases, but the specific implementation process needs to be correspondingly adjusted according to actual conditions. The content of the adjustment comprises: the number of focus navigation modules, the positions of the focus navigation modules and the groove distribution inside the navigation modules.
Example 3
Items were evaluated preoperatively in liver surgery patients, including liver CT examinations. DICOM standard image information of each phase of the thin-layer liver enhancement CT was obtained by the procedure described in example 3 for subsequent reconstruction of the three-dimensional digital liver by open source software (3D sler, https:// www.slicer.org /). In the implementation process, the purpose of three-dimensional reconstruction by selecting the thin-layer liver CT is to more accurately simulate the state of a real liver (the thickness of a common liver CT is 5mm one layer, and the thickness of the thin-layer liver CT is generally 1mm one layer). In addition, structures inside the liver, such as hepatic artery, hepatic duct, portal vein, hepatic vein, focus and the like are marked by means of artificial marking, and simultaneously, structures of tissues extending outside the liver, such as vena cava, common bile duct, gall bladder and the like, are also marked.
The purpose of the above-mentioned labeling is to further perform the segmentation of the three-dimensional digital liver and the projection of lesions on the liver surface. The three-dimensional digital liver is segmented and processed completely according to the portal vein and hepatic vein distribution structure in the liver.
And after the segmentation of the three-dimensional digital liver and the projection of the focus on the liver surface are completed, extracting liver surface data information. The digital liver capsule is smoothed by editing the surface structure, so that jagged noise is eliminated to accurately simulate the state of the real liver, and the editing is realized by software (zbrush 2018, pixold, https:// pixold.
The generated digital versions of the liver segment navigation and positioning module and the liver focus navigation and positioning module (shown in figure 1) are 3D printed by using medical photosensitive resin.
Fig. 1 is a structure diagram of a liver segment navigation and positioning module and a liver focus navigation and positioning module which are edited and generated by further software, wherein 1 is a diaphragm surface navigation module, 2 is a dirty surface navigation module, and 3 is a focus navigation module. Because the focus of the case of fig. 1 is closer to the diaphragmatic module, the focus navigation module is arranged to coincide with the hollowed-out portion in the middle of the diaphragmatic navigation module. As shown in fig. 2, the sealing strips of each module are provided with concave-convex jogged mortise-tenon structures (fig. 2A), and the diaphragm surface sealing strip 1-1 and the dirty surface sealing strip 2-1 are jogged (fig. 2B), so that the separate arrangement is that each navigation module can be combined or detached, thereby being convenient for adjusting each navigation module according to the needs in the operation process. The diaphragm surface groove 1-3 is arranged to delineate the boundary of the liver diaphragm surface section, and the dirty surface groove 2-2 is arranged to delineate the boundary of the liver dirty surface section. The round holes 1-4 which are uniformly arranged are distributed in the middle of each module and are in a hollowed-out state (the diameter is generally 5mm and can be adjusted according to the size of the module), and 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 meanwhile, the lamination condition of the module and the liver is facilitated to be observed.
Each navigation module sealing strip is provided with a concave-convex jogged mortise-tenon structure, the jogged joint between the connected module sealing strips can be better completed and more compact, unnecessary dislocation jogged is prevented to a certain extent, and each navigation module can be combined or detached according to the requirement.
Example 4
In the process of actually applying the navigation positioning module of the present invention, the basic operation is as shown in fig. 4, firstly, the diaphragmatic surface and the dirty surface navigation positioning module are attached to the liver surface, and then the concave-convex mortise and tenon joints are closed by finger pressurization, so that the closed diaphragmatic surface and the dirty surface module are fixedly attached to the liver surface without being influenced by external force. Then through the similar concave-convex joggle mortise and tenon joint structure, the focus navigation positioning module is combined with the liver segment navigation positioning module.
Marking the boundary line of the resected liver segment on the surface of the liver by using an intra-operative electrocoagulation device, removing the liver focus navigation positioning module from the diaphragmatic positioning module by using forceps or vascular forceps, and marking the boundary line of the focus on the surface of the liver by using the electrocoagulation device. Finally, the thin metal sheet is inserted into a gap between the upper sealing strip and the lower sealing strip, the sealing strip is opened in a rotating mode until the concave-convex matched mortise and tenon joint is separated, all liver navigation positioning modules are taken down, and further the operation excision of the liver segment can be implemented.
Fig. 5 is a schematic diagram of an implementation of the liver operation navigation positioning module in an operation process, wherein a shows that the diaphragm surface navigation module 1 and the dirty surface navigation module 2 are attached to the liver 4, and meanwhile, the sealing strips at the upper edge and the lower edge are pressed with force to close an internal mortise and tenon structure. B shows the lesion navigation module 3 closed to the diaphragmatic navigation module 2.C is a sagittal sectional view of the navigation module after the navigation module is closed to the liver, and each navigation module is closely 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 strip is opened in a rotating way until the sealing strip is matched with the tenon-and-mortise joint to be separated.
Example 5
When the focus position and size of the liver change, the position of the focus navigation module also changes. As shown in fig. 6, when the lesion is close to the liver surface, the lesion navigation module 7 is disposed on the dirty surface navigation module 6.D shows that the diaphragm surface navigation module 5 and the dirty surface navigation module 6 are attached to the liver 8, and meanwhile, the sealing strips at the upper edge and the lower edge are pressed with force to enable the concave-convex mortise-tenon structure inside the sealing strips to be closed. E shows the closing of the lesion navigation module 7 to the dirty surface navigation module 6.F is a sagittal sectional view of the navigation module after the navigation module is closed to the liver, and each navigation module is closely 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 strip is opened in a rotating way until the sealing strip is matched with the tenon-and-mortise joint to be separated.
Example 6
When there are a plurality of lesions in the liver, especially when a plurality of lesions are distributed on the diaphragmatic surface and the visceral surface of the liver, the positions of the lesion navigation modules are required to be set on the diaphragmatic surface navigation module and the visceral surface navigation module respectively. When two lesions are located on the hepatic diaphragmatic surface and the hepatic surface, as shown in fig. 7, the first lesion navigation module 11 and the second lesion navigation module 12 are respectively matched with the diaphragmatic surface navigation module 9 and the dirty surface navigation module 10. G shows that the diaphragm surface navigation module 9 and the dirty surface navigation module 10 are attached to the liver 13, and meanwhile, the sealing strips at the upper edge and the lower edge are pressed with force to enable the concave-convex mortise-tenon structure inside the sealing strips to be closed. H shows the closing of the first lesion navigation module 11 to the diaphragmatic navigation module 9,I shows the closing of the second lesion navigation module 12 to the diaphragmatic navigation module 10, j shows the sagittal sectional view of the navigation module after the closing of the liver, each navigation module being closely attached to the liver surface. 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 strip is opened in a rotating way until the sealing strip is matched with the tenon-and-mortise joint to be separated.
According to the generated navigation positioning module for liver surgery, the surface is in a small round hole uniform hollowed-out design, so that the degree of fitting can be observed in the implementation process; the groove design is favorable for marking liver segment boundaries in operation, and the complete closed connection of the periphery of the module and the groove is favorable for maintaining the three-dimensional shape of the module. In addition, the liver focus navigation and positioning module in this embodiment is a single module close to the diaphragm surface, for example, in specific cases, a plurality of focuses or close to the dirty surface are provided, and the corresponding number and positions can be set according to actual situations. The focus navigation module and the diaphragmatic/dirty surface navigation module are detachable through the anastomotic mortise structure, and the device has the following advantages: when the diameter of a focus is overlarge, overlarge errors are generated when the liver segment navigation and positioning module is attached to the surface of the liver, so that the accurate navigation and positioning of the liver segment are affected. At this time, the liver focus navigation positioning module and the liver segment navigation positioning module are combined for use, so that errors caused by incomplete lamination can be reduced as much as possible. And when the position of the liver tumor is required to be marked, the liver focus navigation positioning module can be removed, so that the operation marking is convenient. The combined and detached use design is favorable for smooth operation navigation.
Claims (6)
1. The accurate liver operation navigation positioning device is characterized by comprising a diaphragm surface navigation module (1), a dirty surface navigation module (2) and a focus navigation module (3), wherein a diaphragm surface sealing strip (1-1) is arranged on the periphery of the diaphragm surface navigation module (1), a hollow part is arranged in the middle of the diaphragm surface navigation module (1), a diaphragm surface inner sealing strip (1-2) is arranged on the surface of the diaphragm surface navigation module (1), a diaphragm surface navigation module groove (1-3) and a circular hole (1-4) are arranged on the surface of the diaphragm surface navigation module (1), 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) and a circular hole are arranged on the surface of the dirty surface navigation module (2), and a focus sealing strip (3-1) is arranged on the focus navigation module (3). Each module is connected through a sealing strip, a diaphragm surface sealing strip (1-1) is connected with a dirty surface sealing strip (2-1), and a focus sealing strip (3-1) is connected with a diaphragm surface inner sealing strip (1-2);
Each sealing strip is provided with a concave-convex joggle mortise structure with a concave groove and a convex, and the concave grooves and the convex parts on the two sealing strips connected are mutually matched;
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 navigation module sealing strip (2-1) is provided with a dirty surface groove (2-1-2) and a dirty surface bulge (2-1-1), and the focus sealing strip (3-1) is provided with the groove and the bulge in the same way.
2. The accurate liver surgery navigation positioning device according to claim 1, wherein when the diaphragm surface navigation module (1) is connected with the dirty surface navigation module (2), the diaphragm surface groove (1-1-1) is matched with the dirty surface protrusion (2-1-1), the diaphragm surface protrusion (1-1-2) is matched with the dirty surface groove (2-1-2), and when the focus navigation module (3) is connected with the diaphragm surface navigation module (1), the focus sealing strip (3-1) is provided with grooves and protrusions which are matched with grooves and protrusions on the diaphragm surface inner sealing strip (1-2).
3. The accurate liver surgery navigation positioning device according to claim 1, wherein the focus navigation module (3) is provided with a plurality of focus navigation modules according to actual conditions.
4. An accurate liver surgery navigation positioning device according to claim 1, characterized in that the lesion navigation module (3) is combined with the diaphragmatic surface navigation module (1) or with the dirty surface navigation module (2).
5. The accurate liver surgery navigation positioning device according to claim 1, wherein the focus navigation module (3) is combined with a hollowed-out part in the middle of the diaphragm navigation module (1).
6. The method for preparing the accurate liver surgery navigation positioning device according to claim 1, which is characterized by comprising the following steps:
(1) Obtaining image information: selecting images of each phase of the flat scanning period, the arterial period, the portal vein period and the hepatic vein period, and acquiring CT images as DICOM standard images;
(2) Construction of digital three-dimensional livers: according to the CT image being a DICOM standard image, converting a two-dimensional image into a three-dimensional image by utilizing a Gaussian algorithm, thereby constructing a three-dimensional liver, comprising a liver internal structure: hepatic artery, portal vein, hepatic vein, inferior vena cava, hepatic duct, biliary tract, gall bladder, focus, and perihepatic ligament;
(3) Segmentation of liver: dividing the boundary of each liver segment according to the branches and branch distribution of portal vein and hepatic vein, and marking each liver segment on the surface of the digital three-dimensional liver; a lesion parting line;
(4) Demarcation of lesions: projecting a liver focus on a liver surface closest to the liver surface, so that a contour boundary of the focus is presented on the digital three-dimensional liver surface, the focus is sometimes close to the liver diaphragmatic surface, the focus is sometimes close to the liver surface, and the focus is projected on 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 focus boundary information of the liver;
(6) Carrying out artificial noise reduction treatment 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 content is as follows: firstly, giving a certain thickness (5 mm) to the liver surface, secondly, filling the liver surface with uniformly distributed circular holes, thirdly, giving a certain width (5 mm) to the dividing line of the liver section, fourthly, extracting focus projection on the liver surface part, and basically generating a diaphragm surface navigation module, a dirty surface navigation module and a focus navigation module so far, and fifthly, arranging a sealing strip on the diaphragm surface navigation module, the dirty surface navigation module and the focus navigation module;
(8) And generating a file applicable to the 3D printing format by the navigation module, and completing the manufacture of the navigation module after 3D printing.
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