CN111887817A - 一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法 - Google Patents
一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法 Download PDFInfo
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Abstract
本发明涉及一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，属于医学影像技术领域。本发明将虚拟现实、增强现实等人工智能技术与传统术中超声、吲哚菁绿荧光染色技术融合应用，使外科医生可以将复杂的肝脏解剖结构可视化、三维化，并在术中精确定位肿瘤、规划手术方案、准确显影目标门静脉流域，实时监控并及时修正肝实质离断平面、进行精准解剖性肝切除术。肝脏手术中实时显示供应肿瘤的门静脉分支血流供应区域，精准引导肝脏切除范围，既可切除可能存在于门静脉流域内的的微小转移肿瘤，又能保证剩余肝脏的血供；提高手术精度及安全性、减少手术并发症、改善肿瘤手术疗效。
Description
技术领域
本发明涉及一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，属于医学影像技术领域。
背景技术
门静脉侵犯是肝细胞癌的一项重要生物学特性。临床治疗中，以解剖性肝切除切除荷瘤肝段门静脉流域为目的，可以清除可能残存的微小转移灶，提高肝细胞癌肿瘤学疗效。此外，手术中如果沿肝叶或肝段的解剖间隙离断肝实质，手术中损伤管道少，时间快，出血少，术后胆漏等并发症率下降。
吲哚菁绿(indocyanine green fluorescence，ICG)是一种近红外荧光染料，在近红外光照射下，能激发荧光并被摄像系统捕捉。近年来ICG用于染色肝段，用于引导精准解剖性肝切除。目前的现有技术方法为：1.在术中超声的引导下，穿刺目标肝段的门静脉分支并注射ICG，对拟切除肝段进行染色(正染)；2.将拟切除肝段的门静脉及肝动脉分支分离出来，阻断后从外周静脉内注射ICG，则拟保留的肝脏获得了染色，而拟切除肝段无染色(负染)。该方法在肝脏表面及深部实质内均可清晰持久显示段间乃至亚肝段间界限，对术中准确切除相应肝段有很好的指引作用。因此准确寻找和穿刺目标门静脉分支是该类手术成功的关键；但是由于肝脏内门静脉分支变异度极高，分支数目、分叉的位置、走行方向、与肿瘤的相对位置，每个病人各不相同，而目前术中超声为二维图像，对经验不足的医生而言，很难理解超声图像所对应的解剖结构，导致不能准确寻找和穿刺目标门静脉分支，从而致使目前术中超声引导ICG荧光染色门静脉流域成功率不高。
发明内容
本发明的目的是为解决如何准确的寻找到注射吲哚菁绿荧光造影剂的目标门静脉分支注射位置的技术问题。
为达到解决上述问题的目的，本发明所采取的技术方案是提供一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法；包括以下步骤：
步骤1：患者术前行薄层CT或核磁共振检查，根据检查数据，利用术前三维可视化软件建立肝脏解剖结构及肿瘤的3D模型；
步骤2：利用虚拟现实技术及增强现实技术将上述检查数据生成的肝脏解剖结构3D模型与手术中肝脏实际解剖位置配准、融合；
步骤3：利用融合影像分析肿瘤与门静脉分支关系，找出需要切除的门静脉流域，指导术中超声穿刺目标门静脉分支，注射造影剂，再通过成像仪显影目标门静脉流域；
步骤4：通过显影指示引导精准切除门静脉流域肝组织。
优选地，上述步骤3中注射的造影剂设为荧光造影剂。
优选地，上述步骤3中注射的造影剂设为吲哚菁绿。
优选地，上述步骤3中成像仪设为荧光成像仪。
优选地，上述步骤3中荧光成像仪设于腹腔镜及机器人微创手术平台上。
优选地，上述步骤4中所述通过显影指示设为通过荧光染色指示。
优选地，上述步骤3中造影剂吲哚菁绿浓度设为0.0125mg/ml。
相比现有技术，本发明具有如下有益效果：
1.本发明将虚拟现实、增强现实等人工智能技术与传统手术中超声、最新吲哚菁绿荧光成像技术融合，将复杂的肝脏解剖结构可视化、三维化，并在术中精确定位肿瘤、规划手术方案、准确显影目标门静脉流域，实时监控并及时修正肝实质离断平面、进行精准解剖性肝切除术。
2.与传统方法相比，本发明可以将每个病人的肝脏解剖结构、肿瘤结构三维立体可视化，与术中实际图像融合，便于外科医生理解门静脉分支支配区域，并通过术中超声及ICG荧光染色技术将目标门静脉流域显影，在荧光成像系统下精准切除肿瘤及周围门静脉支配区域，既可切除可能存在于门静脉流域内的的微小转移肿瘤，又能保证剩余肝脏的血供。肝脏手术中实时显示供应肿瘤的门静脉分支血流供应区域，将复杂的肝脏解剖结构可视化，精准引导肝脏切除范围，提高手术精度及安全性、减少手术并发症、改善肿瘤手术治疗疗效。
附图说明
图1为本发明提供的方法过程原理框图；
具体实施方式
为使本发明更明显易懂，兹以优选实施例，并配合附图作详细说明如下：
如图1所示，本发明提供一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法；包括以下步骤：
步骤1：患者术前行薄层CT或核磁共振检查，根据检查数据，利用术前三维可视化软件建立肝脏解剖结构及肿瘤的3D模型；
步骤2：利用虚拟现实技术及增强现实技术将上述检查数据生成的肝脏解剖结构3D模型与手术中肝脏实际解剖位置配准、融合；
步骤3：利用融合影像分析肿瘤与门静脉分支关系，找出需要切除的门静脉流域，指导术中超声穿刺目标门静脉分支，注射造影剂，再通过成像仪显影目标门静脉流域；
步骤4：通过显影指示引导精准切除门静脉流域肝组织。
上述步骤3中注射的造影剂设为荧光造影剂。
上述步骤3中注射的造影剂设为吲哚菁绿。
上述步骤3中成像仪设为荧光成像仪。
上述步骤3中荧光成像仪设于腹腔镜及机器人微创手术平台上。
上述步骤4中通过显影指示设为通过荧光染色指示。
上述步骤3中造影剂吲哚菁绿浓度设为0.0125mg/ml。
虚拟现实技术(Virtual Reality，VR)是利用计算机仿真系统根据CT或核磁共振影像检测数据生成一个虚拟、逼真的患者肝脏解剖3D模型，利用VR眼镜能够使医生完全沉浸在一个虚拟的、交互式的3D立体环境中。在手术中可以帮助术者虚拟进入肝脏内部探索，有助于理解肝内管道解剖细节及与肿瘤的三维关系，并借助虚拟的腹腔镜器械，进行模拟手术，寻找最佳手术方案。
增强现实技术(Augmented Reality，AR)可将病人CT或核磁共振影像检测数据生成的肝脏解剖结构3D模型与术中实时解剖位置进行匹配，与术中现实图像融合。
本发明将虚拟现实、增强现实等人工智能技术与传统手术中超声、吲哚菁绿荧光染色技术融合应用，外科医生可以将复杂的肝脏解剖结构可视化、三维化，并在术中精确定位肿瘤、规划手术方案、准确显影目标门静脉流域，实时监控并及时修正肝实质离断平面、进行精准解剖性肝切除术。术中多模态影像引导可以避免损伤重要管道结构，减少出血，增加了手术的安全性。在荧光成像系统下精准切除肿瘤及周围门静脉支配区域，既可切除可能存在于门静脉流域内的的微小转移肿瘤，又能保证剩余肝脏的血供。肝脏手术中实时显示供应肿瘤的门静脉分支血流供应区域，将复杂的肝脏解剖结构可视化，精准引导肝脏切除范围，提高手术精度及安全性、减少手术并发症、改善肿瘤学疗效。
以上所述，仅为本发明的较佳实施例，并非对本发明任何形式上和实质上的限制，应当指出，对于本技术领域的普通技术人员，在不脱离本发明的前提下，还将可以做出若干改进和补充，这些改进和补充也应视为本发明的保护范围。凡熟悉本专业的技术人员，在不脱离本发明的精神和范围的情况下，当可利用以上所揭示的技术内容而做出的些许更动、修饰与演变的等同变化，均为本发明的等效实施例；同时，凡依据本发明的实质技术对上述实施例所作的任何等同变化的更动、修饰与演变，均仍属于本发明的技术方案的范围内。
Claims (7)
1.一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法；其特征在于：包括以下步骤：
步骤1：患者术前行薄层CT或核磁共振检查，根据检查数据，利用术前三维可视化软件建立肝脏解剖结构及肿瘤的3D模型；
步骤2：利用虚拟现实技术及增强现实技术将上述检查数据生成的肝脏解剖结构3D模型与手术中肝脏实际解剖位置配准、融合；
步骤3：利用融合影像分析肿瘤与门静脉分支关系，找出需要切除的门静脉流域，指导术中超声穿刺目标门静脉分支，注射造影剂，再通过成像仪显影目标门静脉流域；
步骤4：通过显影指示引导精准切除门静脉流域肝组织。
2.如权利要求1所述的一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，其特征在于：所述步骤3中注射的造影剂设为荧光造影剂。
3.如权利要求2所述的一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，其特征在于：所述步骤3中注射的造影剂设为吲哚菁绿。
4.如权利要求3所述的一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，其特征在于：所述步骤3中成像仪设为荧光成像仪。
5.如权利要求4所述的一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，其特征在于：所述步骤3中荧光成像仪设于腹腔镜及机器人微创手术平台上。
6.如权利要求5所述的一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，其特征在于：所述步骤4中所述通过显影指示设为通过荧光染色指示。
7.如权利要求6所述的一种吲哚菁绿荧光联合多模态影像引导肝脏门静脉流域显影方法，其特征在于：所述步骤3中造影剂吲哚菁绿浓度设为0.0125mg/ml。
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| CN113952033A (zh) * | 2021-12-21 | 2022-01-21 | 广东欧谱曼迪科技有限公司 | 一种双源内窥手术导航系统及方法 |
| WO2022033151A1 (zh) * | 2020-08-10 | 2022-02-17 | 嘉兴市第二医院 | 一种基于吲哚菁绿的荧光照相机及其应用 |
| CN115554419A (zh) * | 2022-11-03 | 2023-01-03 | 南京诺源医疗器械有限公司 | 医用胶联合吲哚菁绿在制备肺结节术前定位材料中的应用 |
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| WO2022033151A1 (zh) * | 2020-08-10 | 2022-02-17 | 嘉兴市第二医院 | 一种基于吲哚菁绿的荧光照相机及其应用 |
| CN113952033A (zh) * | 2021-12-21 | 2022-01-21 | 广东欧谱曼迪科技有限公司 | 一种双源内窥手术导航系统及方法 |
| CN115554419A (zh) * | 2022-11-03 | 2023-01-03 | 南京诺源医疗器械有限公司 | 医用胶联合吲哚菁绿在制备肺结节术前定位材料中的应用 |
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