CN112294434B - Iqqa手术规划平台在介入放射学精确体积脾栓塞的应用 - Google Patents

Iqqa手术规划平台在介入放射学精确体积脾栓塞的应用 Download PDF

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CN112294434B
CN112294434B CN202011221675.0A CN202011221675A CN112294434B CN 112294434 B CN112294434 B CN 112294434B CN 202011221675 A CN202011221675 A CN 202011221675A CN 112294434 B CN112294434 B CN 112294434B
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spleen
iqqa
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CN112294434A (zh
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郑文恒
马作红
王玉文
华向东
吴�琳
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Liaoning Cancer Hospital and Institute
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Abstract

本发明涉及介入放射学和临床医学技术领域，具体涉及IQQA手术规划平台在介入放射学精确体积脾栓塞的的应用。IQQA手术规划平台在介入放射学精确体积脾栓塞中的应用。IQQA手术规划平台在预测脾栓塞预后中的应用，包括外周血象变化、脾脏血流动力学及术后并发症。本发明采用IQQA平台术前计划、术中指导、术后验证进行精确体积栓塞，可以使部分性脾栓塞治疗术从经验依赖性操作转化为客观数据指导，从而降低了临床风险，提高了临床疗效。

Description

IQQA手术规划平台在介入放射学精确体积脾栓塞的应用
技术领域
本发明涉及介入放射学和临床医学技术领域，具体涉及IQQA手术规划平台在介入放射学精确体积脾栓塞的应用。
背景技术
对肝硬化及其他各种原因所致的脾肿大、脾功能亢进，传统的方法是开腹或腹腔镜下脾切除。由于外科脾切除术减少了抗体的生成，涉及较多严重的并发症如：术后凶险性感染(overwhelming post-splenectomy infection，OPSI)、败血症、出血、门静脉血栓形成等，脾切除后无脾状态、免疫抑制治疗特别是放射治疗可能是OPSI的基础。因此寻找一种有效、微创的治疗方法就具有重要的临床意义。应用部分性脾栓塞术(partial splenicembolization, PSE)可达到非手术性脾切除目的，研究证实经导管动脉栓塞60%～70%脾脏可显著改善脾功能亢进，而残余30%～40%脾组织具有免疫保护功能防止败血症的发生。PSE也为不能手术者提供了生存机会，成为替代外科性脾切除术的重要方法。目前栓塞体积的评估多是根据术者经验或术中DSA二维图像评估，缺乏客观性、准确性。部分性脾栓塞（PSE）是临床上治疗脾功能亢进的较为常规的技术；然而术中栓塞体积决定了脾亢病情的改善情况以及术后并发症的发生风险。既往PSE术中栓塞体积的评估多是依赖术者的经验判断，缺乏客观的数据支持。
IQQA 智能交互的定性与定量分析（Intelligent/Interactive Qualitative andQuantitative Analysis） 技术平台已通过美国FDA、国家药品监督管理局NMPA及欧盟CE等多方国际认证，可以提供先进的信息分析技术来改进并优化临床工作的流程和准确性。有效应用于各种癌症的早期检测与诊断、术前精准模拟规划、术中影像全程引导监测及实时导航、术后定量评估及随访。目前，IQQA手术规划平台在肝胆外科等领域应用成熟，然而在介入放射学精确体积脾栓塞的应用国内外未有报道。
发明内容
鉴于现有技术存在的问题,本发明的目的是提供IQQA手术规划平台在介入放射学精确体积脾栓塞的应用。借助IQQA手术规划平台可以行脾脏动脉分支重建，并可以计算分支动脉供应脾脏的体积，可以在术前精确指导预计栓塞体积、术后精确评估栓塞体积。
为实现上述目的，本发明采用以下技术方案。
IQQA手术规划平台在介入放射学精确体积脾栓塞中的应用。
IQQA手术规划平台在预测脾栓塞预后中的应用。
进一步地，包括外周血象变化、脾脏血流动力学及术后并发症。
IQQA手术规划平台在介入放射学精确体积脾栓塞的方法，具体步骤如下。
步骤1、PSE术前依据脾脏的增强CT信息，应用IQQA平台明确脾动脉的分支情况并获得相应脾脏体积；依据多普勒超声测量脾动脉主干及各组分支的血流速度及脾静脉血流速度。
步骤2、PSE术中严格按照术前计划结合术中情况进行动脉有效组合，确保拟栓塞体积达到50%-80%。
步骤3、PSE术后进行随访；计划随访时间为12个月，时间节点为术后1周、1个月、3个月、6 个月、12个月；具体随访内容：外周血象、依据IQQA平台计算栓塞体积、脾脏动静脉血流速度变化及PSE相关并发症的观察。
与现有技术比，本发明的有益效果如下。
部分性脾栓塞（PSE）是临床上治疗脾功能亢进的较为常规的技术，然而术中栓塞体积决定了脾亢病情的改善情况以及术后并发症的发生风险。既往PSE术中栓塞体积的评估多是依赖术者的经验判断，缺乏客观的数据支持。本发明采用IQQA平台术前计划、术中指导、术后验证进行精确体积栓塞，可以使部分性脾栓塞治疗术从经验依赖性操作转化为客观数据指导，从而降低了临床风险，提高了临床疗效。
附图说明
图1是患者者术前脾脏动脉分支重建及分支动脉供应脾脏的体积。
图2是术后验证在IQQA手术规划平台下脾脏坏死情况达到的预期临床效果。
具体实施例
下面结合具体实施和附图例对本发明进行详细说明。
实施例 IQQA手术规划平台在介入放射学精确体积脾栓塞的应用。
一、研究对象：肝硬化（伴或不伴肝癌）所致的脾功能亢进的病人。
纳入标准：1）临床诊断符合肝硬化（伴或不伴肝癌）所致的脾功能亢进的病人，年龄在18-75周岁；2）血小板低于60x 10^9/l；3）肝脏功能Child-pough评分为A级和B级。
排除标准：1）存在严重凝血功能障碍；2）各种原因不适合PS；3）肝功能Child-pough评分为C级；4）存在其他重要脏器严重的功能障碍。
二、方法。
1）依据病例术前影像学资料，应用IQQA手术规划平台，按照脾脏动脉分支分布，按照2级分支计算出其相应的脾脏体积，并设计术前栓塞区域（总脾脏体积40%-60%）。
2）PSE术中，根据动脉造影与IQQA手术规划平台拟合计划栓塞的动脉分支进行栓塞，并通过术后造影明确完成情况。
3）依据病例术后1周影像学资料，应用IQQA手术规划平台，计算出栓塞区域体积，并对照与术前计划的拟合度。
4）术前及术后1周通过彩色多普勒超声测量脾动脉及脾静脉的血流动力学改变。
5）通过术前及术后及1年的随访资料，判断栓塞前后疗效及安全性；并进一步明确最佳的区域性栓塞体积及方法。
患者术前脾脏动脉分支重建及分支动脉供应脾脏的体积如图1所示。而基于其所示提供的信息，再进行术中精准的PSE手术，术后验证在IQQA手术规划平台下脾脏坏死情况达到了预期临床效果，如图2所示。
三、主要评价指标。
依据IQQA平台行精确体积脾栓塞的可行性，即术前计划和术后验证情况。
依据IQQA平台行精确体积脾栓塞的临床疗效，包括外周血象变化、脾脏血流动力学及术后并发症。
四、结果。
采用IQQA平台术前计划、术中指导、术后验证进行精确体积栓塞，可以使部分性脾栓塞治疗术从经验依赖性操作转化为客观数据指导，从而降低了临床风险，提高了临床疗效。

Claims (1)

1.一种预测脾栓塞体积的规划平台，其特征在于，所述规划平台为IQQA；
所述平台包括以下模块：
脾脏体积计算及术前设计模块，依据病例术前影像学资料，按照脾脏动脉分支分布，按照2级分支计算出相应的脾脏体积，并设计术前栓塞区域；
栓塞拟合模块，PSE术中，根据动脉造影拟合计划栓塞的动脉分支，确保拟栓塞体积达到50%-80%，进行栓塞，并通过术后造影明确完成情况；
栓塞区域体积计算模块，依据病例术后1周影像学资料，计算出栓塞区域体积，并对照与术前计划的拟合度；
所述影像学资料为依据多普勒超声测量脾动脉主干及各组分支的血流速度及脾静脉血流速度。
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