WO2019184158A1 - Procédé de préparation d'un modèle de segment de poumon quantifié au moyen d'un marqueur inter-segmentaire - Google Patents

Procédé de préparation d'un modèle de segment de poumon quantifié au moyen d'un marqueur inter-segmentaire Download PDF

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WO2019184158A1
WO2019184158A1 PCT/CN2018/096936 CN2018096936W WO2019184158A1 WO 2019184158 A1 WO2019184158 A1 WO 2019184158A1 CN 2018096936 W CN2018096936 W CN 2018096936W WO 2019184158 A1 WO2019184158 A1 WO 2019184158A1
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segment
lung
edge
junction
section
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PCT/CN2018/096936
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Chinese (zh)
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刘伦旭
徐昱扬
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四川大学华西医院
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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
    • 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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  • the invention relates to a method for determining an inter-segment landmark of a lung and a method for preparing a quantitative lung segment model.
  • the “lung expansion-frozen method” is usually used to determine the inter-segment plane: the target segment bronchus is clamped and the lungs are drummed, and the target segment bronchus is identified correctly; the target segment bronchus is cut off and the lung is again swelled. In the presence of inter-alveolar pores, the lung tissue of the target segment also swells.
  • the ventilation is stopped, and the lungs of the remaining lung segments are successively collapsed, while the lungs of the target segment are continuously inflated, and the relative boundary between the collapsed lung tissue and the inflated target segment lung tissue is determined. Plane and mark the lung surface with an electric knife.
  • the drawback of this method is that the terminal bronchioles may be in mutual communication, often resulting in poor collapse of the target lung segment and unclear flatness between the segments.
  • ICG indocyanine green
  • the present invention firstly provides a method for determining the inter-segment marker points of the lung, which can easily obtain the "digital segmentation point of the lung segment" of each person, thereby providing a
  • the method of preparing the lung segment model is to facilitate accurate segmental resection of the hospital at all levels.
  • the invention provides a method for determining the inter-segment landmarks of a lung, the steps are as follows:
  • CT lung chest venography and high-resolution thin-layer scanning were performed on the lungs to be examined; three-dimensional reconstruction of the original image was performed, and bronchial trees were generated according to the shape of the bronchi, leaf bronchus, segmental bronchi, sub-bronchus and terminal bronchioles.
  • the three-dimensional model is used to construct a three-dimensional lung segment image; and the boundary range of the lung segment image model generated based on the three-dimensional reconstruction of the bronchial tree is accurately defined by the path of the intervenous vein;
  • the method for determining the marker points between the segments of the lungs is as follows:
  • CT chest pulmonary vein angiography and high-resolution thin-layer scanning are performed on the lungs to be examined, and data between anatomical points, boundary lines and their connections on the surface of the lungs are measured;
  • step (1) the data of the anatomical structure recognizable on the surface of the lung is as follows:
  • the outer edge of the bottom edge the bottom edge of the left lower lobe is divided into two parts, namely the inner line of the bottom edge (medial side) and the outer line of the bottom edge (rib side), the front end is the intersection of the oblique crack and the bottom edge, and the rear end is the trailing edge. The intersection with the bottom edge.
  • the inner edge of the bottom edge the bottom edge of the right lower lobe is divided into two parts, namely the inner line of the bottom edge (medial side) and the outer line of the bottom edge (rib side), the front end is the intersection of the oblique fissure and the bottom edge, and the rear end is the mediastinum. The intersection of the front and the front.
  • step (2) the way to determine the position of the marker points between the segments is as follows:
  • intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection ;
  • the boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
  • the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • the anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment. 3/5 outside the junction of the junction;
  • the junction point between the leading edge of the leading edge and the front segment is located at the midpoint of the leading edge of the upper lobe;
  • the boundary point between the posterior edge and the tip segment is about the midpoint of the posterior edge of the upper lobe
  • the boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
  • the boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
  • the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • the anterior and posterior horn of the left lung the left upper lobe obliquely and the leading edge will be in the anterior inferior horn; the right anterior superior anterior horn: the right upper lobe horizontal fissure intersects the leading edge to form the anterior inferior horn.
  • the method for preparing a lung segment model of the present invention comprises the steps of: measuring data of an anatomical structure recognizable by the lung, preparing a lung model, and then installing each segment on the lung model according to the position of the marker points between the segments determined according to the foregoing method. Mark points.
  • the method of the invention can accurately determine the position of the marker points between the segments, so that the abstract inter-segment plane can be quantized, can guide the surgeon to perform precise segmentectomy, and further prepare the segment model for the surgeon to pre-operatively treat the lungs
  • the anatomical structure of the segment is clear at a glance and the application prospect is good.
  • Figure 1 shows the remaining identifiable anatomy of the lung surface
  • Figure 2 shows the lateral view of the left lung and the marker points between the upper segments of the left lung.
  • Figure 3 shows the marker points between the segments of the left lower lobe.
  • Figure 4 shows the lateral view of the right lung and the marker points between the upper segments of the right lung.
  • Figure 5 shows the marker points between the segments of the right lower lobe.
  • Figure 6 is a front elevational view showing the left lung segment of the left upper lobe and the right lung segment of the right upper lobe;
  • Figure 7 is a front elevational view showing the left lung segment of the left lower lobe in the present embodiment
  • Figure 8 is a rear elevational view of Figure 7;
  • Figure 9 is a right side view of Figure 7;
  • Figure 10 is a bottom view of Figure 7;
  • Figure 11 is a front elevational view of the right lung segment of the right lower lobe of the right lung;
  • Figure 12 is a rear elevational view of the right lower lobe of the present embodiment.
  • Figure 13 is a left side view of Figure 11;
  • Figure 14 is a right side view of Figure 11;
  • Figure 15 is a bottom view of Figure 11;
  • 1 is the posterior segment
  • 2 is the left anterior segment
  • 3 is the tongue segment
  • 4 is the left lung oblique fissure
  • 5 is the left lung lobe
  • 6 is the tip segment
  • 7 is the posterior segment
  • 8 is the right lung anterior segment.
  • 9 is the right middle lobe
  • 10 is the right lower lobe
  • 11 is the left lung dorsal segment
  • 12 is the left lung posterior basal segment
  • 13 is the left extrapulmonary basal segment
  • 14 is the anterior basal segment
  • 15 is the left lung oblique fissure and
  • 16 is the right lung dorsal segment
  • 17 is the anterior basal segment
  • 18 is the right extrapulmonary basal segment
  • 19 is the right posterior basal segment
  • 20 is the right lung basal segment
  • 21 is the right middle lobe
  • 22 is the transition of the right lung oblique fissure and the right lung mediastinum.
  • Example 1 Method for determining inter-segment landmarks of the lung of the present invention
  • the anatomical structures recognizable on the surface of the lung include the tip of the lung, the base of the lung, the rib surface on the outer side, the mediastinum on the medial side, and the leading edge, the trailing edge, and the lower edge.
  • the remaining anatomical structures of the left lung are: the posterior sloping cleft (the intersection of the oblique fissure and the trailing edge) (Fig. 1A); the anterior and posterior horn of the left upper lung (the intersection of the oblique fissure and the leading edge) (Fig. 1A); The anterior oblique lobes of the lower lobe and the transitional part of the mediastinum (Fig. 1B); the lower edge of the left lower lobe is divided into two parts, namely the medial line on the bottom edge (medial side) and the lateral line on the bottom edge (rib side), front end It is the rib side intersection of the oblique plane and the bottom edge (Fig. 1C), and the rear end is the intersection of the oblique plane and the mediastinum side of the bottom edge (Fig. 1C).
  • the remaining identifiable anatomical structures of the right lung are: the dorsal end of the oblique fissure (the intersection of the oblique fissure and the trailing edge) (Fig. 1D); the intersection of the horizontal fissure and the oblique fissure (Fig. 1D); the lower right anterior superior anterior horn (horizontal fissure and anterior The intersection of the margins (Fig. 1D); the transitional section of the anterior oblique lobe and the mediastinum of the right lower lobe pulmonary ligament (Fig. 1E); the right lower lobe is divided into two parts, the medial line of the inferior border (medial side) and The outer edge of the bottom edge (rib side) (Fig. 1F), the front end is the intersection of the oblique side and the rib side of the bottom edge, and the rear end is the intersection of the oblique plane and the mediastinal side of the bottom edge (Fig. 1F).
  • the length of the anatomical structure can be identified by measuring the leading edge or the like, and the inter-segment marking points are determined by the calculation scheme provided by the present invention.
  • the subject was subjected to CT chest venous venography + high-resolution thin-layer scanning (Simens SOMATOM Definition Flash CT), and the obtained original two-dimensional image was stored in the Digital Imaging and Communications in Medicine (DICOM) format.
  • DICOM Digital Imaging and Communications in Medicine
  • IQQA-3D Pre-operative Assessment and Treatment Plan Aid System for Thoracic Lungs developed by EDDA Technology and SOFTWARE (Shanghai) Co., Ltd. (provided by EDDA Technology)
  • the inter-segment mark The positional relationship of the point to the anatomical structure recognizable on the surface of the lung is measured.
  • the inter-segment markers of the lung segments of the upper left lobe are shown in Figure 2. Including: the boundary point between the front and the front of the leading edge; the boundary between the front and the tongue of the leading edge; the boundary between the rear and the tongue of the oblique tip; the intersection of the rear, front and tongue of the tip at the rib.
  • the measured data is: (1) the length of the leading edge; (2) the length of the oblique split.
  • intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection .
  • the inter-segmental markers of the lung segments of the left lower lobe are shown in Figure 3. Including: the boundary point between the oblique fractured segment and the anterior basal segment; the junction between the oblique segment and the medial segment of the mediastinum and the anterior basal segment (at the same level as the junction between the oblique segment and the anterior basal segment) Position); the junction point between the dorsal segment of the posterior margin of the left lower lung and the posterior basal segment; the intersection of the dorsal segment, the anterior inner segment and the outer base segment at the rib surface; the intersection of the dorsal segment, the outer base segment and the posterior base segment at the rib surface Point; the intersection of the back section, the front inner base section and the rear base section at the mediastinum; the boundary point between the inner base section and the outer basement section of the outer edge of the bottom edge; the boundary point between the outer basement section and the rear basement section of the outer edge of the bottom edge.
  • the measured data are: (1) the length of the trailing edge of the left lower lung; (2) the length of the lateral line of the bottom margin.
  • the boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
  • the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • the dorsal segment (here, the dorsal segment refers to the dorsal segment of the left lower lobe), the intersection of the anterior basal segment and the outer basal segment at the rib surface is located at the junction of the dorsal and posterior basal segments of the posterior margin and the oblique fissure The junction point between the back section and the front inner base section is at the first 3/10 of the line connecting the ribs;
  • the anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment.
  • the junction point is 3/5 outside the line.
  • the inter-segmental markers of the lung segments of the right upper lobe are shown in Figure 4. Including: the junction point of the leading edge and the front section; the junction point of the trailing edge and the rear section; the junction point of the front section and the back section of the horizontal section; the intersection point of the tip section, the back section and the front section at the rib surface.
  • the measured data are: (1) the length of the right upper lung leading edge; (2) the length of the right upper lung posterior margin; and (3) the length of the horizontal split.
  • junction point between the leading edge of the leading edge and the anterior segment is located at the midpoint of the leading edge of the right upper lung
  • the marker points between the segments of the right lower lobe are shown in Figure 5.
  • the method includes: a boundary point between the oblique split back section and the front basement section; a boundary point between the oblique split surface and the longitudinal section of the longitudinal partition portion and the inner basement section (at the same horizontal position as the boundary point between the oblique split back section and the front basement section); The intersection of the back section, the front base section and the outer base section at the rib surface; the intersection of the back section, the outer base section and the rear base section at the rib surface; the intersection of the back section, the inner base section and the rear base section at the mediastinum The intersection of the back section, the inner base section and the front section at the oblique plane; the junction of the trailing edge back section and the rear basement section; the boundary point between the basement section and the front basement section in the inner edge of the bottom edge; a junction point between the segment and the outer base segment; a boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge;
  • the measured data are: (1) the length of the oblique fissure; (2) the length of the posterior edge of the right lower lung; (3) the length of the inner line of the bottom edge; and (4) the length of the outer line of the bottom edge.
  • the boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
  • the junction between the posterior anterior and posterior basal segments is located at the upper 2/5 of the posterior border of the right lower lobe (where the posterior border of the lower lobe refers to the posterior border of the right lower lung);
  • the boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
  • the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • intersection of the dorsal segment, the anterior basal segment and the inner basal segment at the oblique plane is located at the junction of the oblique cleft segment and the anterior basal segment and the boundary between the oblique segment and the medial segment of the mediastinum (ie, at the midpoint of the line connecting the oblique plane and the mediastinum, at a point parallel to the position of the point (1) (ie, the point of intersection of the oblique fracture back and the anterior basement);
  • the above method was used to determine the ratio of the length between the inter-segment marking points of each lung segment to the length of the anatomical structure of the lung surface according to gender, age, body weight and height. There was no statistical difference between the groups, indicating the proportional length determined by the present invention. The consistency among different individuals is very good, and it can reflect the true position of the marker points between the segments, and can be widely used in different patients.
  • the reconstruction of the pulmonary vein was added during the three-micro reconstruction. It is known that the inter-segmental veins are shaped between the lung segments. Therefore, according to the shape of the inter-segmental vein, the accuracy of the size of the lung segment can be confirmed, thereby indirectly verifying the lung segment. The accuracy of the marker points.
  • a lung model was prepared according to the data of the lung recognizable anatomy of each patient measured in Example 1, and then the inter-segment marker points were installed on the lung model according to the position of the inter-segment marker points determined by the method of Example 1.
  • the lung segment model prepared by the method of the present invention is as follows:
  • the left lung segment includes: a left lung upper lobe, a left lung lobe, a left lung rib surface, a left lung mediastinum; the left lung lobe and The junction of the left lower lobe is a left lung oblique fissure;
  • the left lobe upper lobe includes: a posterior segment of the left lung, a anterior segment of the left lung, and a segment of the tongue;
  • the lower lobe of the left lung includes: a segment of the left lung, a anterior basal segment, and a left Extrapulmonary basal segment, left posterior basal segment;
  • said right segment includes: right upper lobe, right middle lobe, right lower lobe, right lung rib, right lung mediastinum; right lung upper lobe and right
  • the junction of the middle lobe of the lung is a horizontal split of the right lung;
  • the junction of the right middle lobe and the right lower lobe is a right lung ob
  • the method further includes: an inter-segment mark point;
  • the inter-segment marking points include:
  • a junction between the posterior segment of the tip and the anterior segment of the left lung at the anterior border of the left lung; the junction of the anterior segment of the left lung and the lingual segment at the anterior border of the left lung; the posterior segment of the tip, the anterior segment of the left lung, and the segment of the tongue are a junction point of the left lung rib surface; the tip posterior segment and the tongue segment at the junction of the left lung oblique fissure;
  • the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure a junction of the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure; the right lung dorsal segment, the anterior basal segment, and the right extrapulmonary basal segment at a junction of the right pulmonary rib surface; a junction of the right lung dorsal segment, the right extrapulmonary basal segment, and the right posterior pulmonary basal segment at the right lung rib surface; the right lung dorsal segment and the right pulmonary basal segment in the right lung oblique fissure and the right lung mediastinum a junction point of the facial transition portion; a junction of the right lung dorsal segment, the right pulmonary basal segment, and the right posterior pulmonary basal segment at the right lung rib surface; the right lung dorsal segment and the right lung posterior basal segment at the right a junction point of the posterior lung; the right anterior segment, the anterior basal segment, and the right lung
  • the junction of the posterior anterior segment and the left anterior segment at the left lung anterior border is located at the upper 1/5 of the left lung anterior border; the left lung anterior segment and the tongue segment are located at the junction of the left pulmonary anterior border The upper 3/5 of the left lung leading edge; the tip posterior segment and the tongue segment at the junction of the left lung oblique fissure are the first junction point, and the left lung anterior segment and the tongue segment are at the left lung leading edge
  • the junction point is a second junction point, and the intersection point of the tip posterior segment, the left lung anterior segment, and the tongue segment at the left lung rib surface is located at the intersection of the first junction point and the second junction point.
  • the tip posterior segment and the tongue segment are located at the upper 2/5 of the left lung oblique fissure at the junction of the left lung oblique fissure;
  • the left lung dorsal segment and the anterior basal segment at the junction of the left lung oblique fissure are located at the upper 2/5 of the left lung oblique fissure; the left lung dorsal segment and the left posterior basal segment in the left lung
  • the junction of the posterior margin is located at the midpoint of the posterior edge of the left lung; the junction of the anterior basal segment and the posterior ligament of the left lung at the lateral line of the left lung rim is located within the lateral line of the left lung margin 10;
  • the junction between the anterior basal segment and the left extrapulmonary basal segment at the lateral line of the left lung rim is located at the outer 1/4 of the lateral line of the left lung rim; the left extrapulmonary basal segment and the left
  • the junction point of the posterior lung basal segment at the lateral line of the left lung bottom edge is located at the midpoint of the lateral line of the left lung bottom edge; the junction between the left lung dorsal segment and the left posterior basal segment at the posterior border of the left lung
  • the junction between the tip segment and the right lung anterior segment at the right lung anterior border is located at a midpoint of the left lung anterior border; the right lung anterior segment and the posterior segment at the junction of the right lung horizontal fissure are located at the right lung level
  • the first 4/5 of the split; the posterior segment of the right lung and the anterior segment of the right lung at the posterior border of the right lung are located at the midpoint of the posterior margin of the right lung; the tip, the posterior, and the right lung are in the right lung
  • the intersection of the rib surface and the junction of the right lung anterior segment and the posterior segment at the junction of the right lung horizontal fissure, and the angle of the right lung horizontal fissure is 90 degrees;
  • the boundary between the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure is located at the upper 2/5 of the right lung oblique fissure; the right lung dorsal segment and the right posterior pulmonary basal segment are behind the right lung
  • the junction of the rim is located at the upper 2/5 of the posterior edge of the right lung; the junction of the anterior basal segment and the basal segment of the right lung at the bottom line of the right lung is located at the bottom line of the right lung
  • the midpoint of the right lung and the posterior lung basal segment at the lateral line of the right lung bottom edge are located at 1/10 of the outer line of the right lung bottom edge; the anterior basement segment a junction point of the right extrapulmonary basal segment at the lateral line of the right lung bottom edge is located at 1/4 of the lateral line of the right lung bottom edge; the right extrapulmonary basal segment and the right posterior basal segment are in the right lung a junction point of the lateral line of the bottom edge is located at a midpoint of
  • the lung segment model prepared by the method of the invention simulates the real left and right lung segments of the human body, installs inter-segment landmarks on the lung segment model, and precisely defines the position of the marker points between the segments, so that the abstract inter-segment plane can be Quantification allows the surgeon to see the anatomy of the lung segment at a glance before surgery, thus guiding the surgeon to perform accurate segmentectomy.
  • the detachable connection between the various lung segments of the model makes the anatomical relationship between the various lung segments clearer, further satisfying the needs of doctors' teaching and research.

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Abstract

L'invention concerne un procédé pour déterminer un marqueur inter-segmentaire d'un poumon et un procédé de préparation d'un modèle de segment de poumon quantifié. Le procédé pour déterminer un marqueur inter-segmentaire comprend les étapes de : (1) réaliser une veinographie veineuse de la poitrine par tomographie assistée par ordinateur (CT) et un balayage de couche mince à haute résolution sur un poumon soumis à un examen ; et réaliser une reconstruction tridimensionnelle et d'autres opérations sur une image d'origine ; et (2) déterminer un marqueur de structure anatomique identifiable et une ligne de limite sur la surface du poumon, et utiliser les structures comme points de référence pour mesurer une relation de position relative entre une position inter-segmentaire de chaque segment de poumon sur la surface du poumon et le marqueur de structure anatomique de poumon identifiable, calculer une proportion de longueur de celle-ci sur une ligne de marquage anatomique au moyen de données volumineuses, de façon à déterminer la position d'un marqueur inter-segmentaire. Le procédé est adopté pour permettre une détermination précise des positions de marqueurs inter-segmentaires, et pour quantifier des plans inter-segmentaires abstraits de façon à guider un chirurgien pour effectuer une segmentectomie précise. Un modèle de segment de poumon est en outre préparé, de telle sorte que le chirurgien peut facilement observer la structure anatomique de segments de poumon avant la chirurgie. L'invention présente un certain potentiel pour une application étendue.
PCT/CN2018/096936 2018-03-29 2018-07-25 Procédé de préparation d'un modèle de segment de poumon quantifié au moyen d'un marqueur inter-segmentaire WO2019184158A1 (fr)

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US20160005224A1 (en) * 2014-07-02 2016-01-07 Covidien Lp Unified coordinate system for multiple ct scans of patient lungs
CN104504737A (zh) * 2015-01-08 2015-04-08 深圳大学 一种从肺部ct图像获得三维气管树的方法

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