数字智能化诊疗技术在围肝门胆道疾病术前评估中的意义
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摘要
目前三维可视化、3D打印、增强或虚拟现实技术、吲哚菁绿(ICG)分子影像学技术等数字智能化诊疗技术正广泛应用于肝胆胰疾病的临床诊治,呈蓬勃发展之势。围肝门胆道疾病是外科领域中重大疑难疾病,其解剖结构复杂、生理病理特殊,诊疗效率较低。高效的术前评估是提高其诊疗效率的关键环节。数字智能化诊疗技术可获取疾病全面的、个体化的影像诊断信息,全方位分析肝动脉、门静脉、胆管与病灶的解剖关系,测量肝脏体积,进而制定合理的手术方案,确定最佳手术入路,预判术中副损伤风险,提高围肝门胆道疾病的外科治疗效果。
The digital intelligent medical technology such as three dimensional visualization, three dimensional printing,enhanced/virtual reality technology, indocyanine green molecular imaging are widely used in the clinical diagnosis and treatment of hepatobiliary and pancreatic diseases and showed a booming trend. Perihepatic hilar biliary tract diseases with complex anatomical structure, special physiological pathology character and lower efficiency of diagnosis and treatment are the major and difficult disease in the field of surgery. Efficient preoperative evaluation is the key to improve the efficiency of diagnosis and treatment. The digital intelligent medical technology can be used to obtain the comprehensive, individualized image diagnostic information,and comprehensive analysis the anatomy relations of the hepatic artery, portal vein, bile duct and lesions, and quantitatively measure the liver volume, formulate the reasonable operation scheme, determine the best approach of surgery, predict intraoperative injury risk and improve the surgical treatment effect.
The digital intelligent medical technology such as three dimensional visualization, three dimensional printing,enhanced/virtual reality technology, indocyanine green molecular imaging are widely used in the clinical diagnosis and treatment of hepatobiliary and pancreatic diseases and showed a booming trend. Perihepatic hilar biliary tract diseases with complex anatomical structure, special physiological pathology character and lower efficiency of diagnosis and treatment are the major and difficult disease in the field of surgery. Efficient preoperative evaluation is the key to improve the efficiency of diagnosis and treatment. The digital intelligent medical technology can be used to obtain the comprehensive, individualized image diagnostic information,and comprehensive analysis the anatomy relations of the hepatic artery, portal vein, bile duct and lesions, and quantitatively measure the liver volume, formulate the reasonable operation scheme, determine the best approach of surgery, predict intraoperative injury risk and improve the surgical treatment effect.
引文
[1]王坚,陈炜.围肝门外科技术在胆道外科的应用[J].中华消化外科杂志,2015,14(4):284-287.
[2]孟翔飞,段伟东,王学栋,等.计算机3D技术研究围肝门部门静脉变异者胆管变异率[J].中国临床解剖学杂志,2016,34(2):155-159.
[3]Yang Y,Zhou Z,Liu R,et al.Application of 3D visualization and 3D printing technology on ERCP for patients with hilar cholangiocarcinoma[J].Exp Ther Med,2018,15(4):3259-3264.
[4]方驰华,蔡伟,范应方,等.从数字虚拟人到三维可视化肝脏3D打印[J].中国实用外科杂志,2016,36(1):47-50.
[5]莫志康,方驰华,项楠,等.三维可视化辅助3D腹腔镜、胆道硬镜肝胆管结石靶向碎石术并发症防治研究[J].中国实用外科杂志,2017,37(3):284-287.
[6]Sampogna G,Pugliese R,Elli M,et al.Routine clinical application of virtual reality in abdominal surgery[J].Minim Invasive Ther Allied Technol,2017,26(3):135-143.
[7]李斌,姜小清.“肝门”概念的解剖学发展及其临床意义[J].中华肝胆外科杂志,2018,24(7):433-436.
[8]孟翔飞,董家鸿,黄志强.围肝门部胆管临床解剖学研究进展[J].中华外科杂志,2010,48(13):1022-1026.
[9]中华医学会数字医学分会,中华医学会外科学分会胆道外科学组,中国研究型医院学会数字医学临床外科专业委员会.胆囊癌三维可视化诊治专家共识(2018版)[J].中国实用外科杂志,2018,38(12):1339-1346.
[10]王坚,闫加艳.围肝门外科技术在高位胆管损伤修复中的应用[J].外科理论与实践,2017,22(3):215-217.
[11]郑树国.腹腔镜技术在肝脏外科的拓展应用[J].中华消化外科杂志,2013,12(5):324-327.
[12]黄志强.今日胆道外科[J].中华实验外科杂志,2011,28(11):1827-1828.
[13]王坚.围肝门外科技术在复杂肝内胆管结石再手术中的应用[J].肝胆外科杂志,2017,25(3):161-163.
[14]顾奇云,赵军,周国庆,等.胆石症合并肝硬化门静脉高压症的治疗经验[J].中华普通外科杂志,2014,29(4):292-294.
[15]方驰华,方兆山,蔡伟,等.肝胆管结石三维可视化诊治平台构建及临床价值研究[J].中国实用外科杂志,2015,35(9):974-978.
[16]杨世忠.计算机辅助手术规划系统在肝门部胆管癌治疗中应用现状及展望[J].中国实用外科杂志,2013,33(1):47-50.
[17]林科灿,曾永毅,黎蕴通,等.三维重建虚拟手术规划在肝门部胆管癌手术中的应用价值[J].中华消化外科杂志,2018,17(4):383-388.
[18]Mansour JC,Aloia TA,Crane CH,et al.Hilar cholangiocarcinoma:expert consensus statement.[J].HPB,2015,17(8):691-699.
[19]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.复杂性肝脏肿瘤三维可视化精准诊治专家共识[J].中国实用外科杂志,2017,37(1):53-59.
[20]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.肝门部胆管癌三维可视化精准诊治专家共识[J].中国实用外科杂志,2017,37(1):48-52.
[21]Shimizu H,Hosokawa I,Ohtsuka M,et al.Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy[J].World J Surg,2014,38(12):3210-3214.
[22]曾宁,方驰华,范应方,等.肝门部胆管癌三维可视化精准诊疗平台构建及临床应用[J].中华外科杂志,2016,54(9):680-685.
[23]Zeng N,Tao H,Fang C,et al.Individualized preoperative planning using three-dimensional modeling for Bismuth and Corlette type III hilar cholangiocarcinoma[J].World J Surg Oncol,2016,14(1):44.
[24]Miyamoto R,Oshiro Y,Hashimoto S,et al.Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma[J].World J Gastroenterol,2014,20(32):11451-11455.
[25]Okuda Y,Taura K,Seo S,et al.Usefulness of operative planning based on 3-dimensional CT cholangiography for biliary malignancies[J].Surgery,2015,158(5):1261-1271.
[26]Zhang J,Qiao QL,Guo XC,et al.Application of three-dimensional visualization technique in preoperative planning of progressive hilar cholangiocarcinoma[J].Am J Transl Res,2018,10(6):1730-1735.
[27]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.肝胆管结石三维可视化精准诊治专家共识[J].中国实用外科杂志,2017,37(1):60-66.
[28]方驰华,刘允怡.数字化胆道外科学[M].北京:人民卫生出版社,2018:207-208.
[29]武涛,张兴凯,范德增.3D生物打印技术及其外科临床应用[J].中国实用外科杂志,2015,35(5):570-572.
[30]方驰华,蔡伟,范应方,等.从数字虚拟人到三维可视化肝脏3D打印[J].中国实用外科杂志,2016,36(1):47-50.
[31]Zheng YX,Yu DF,Zhao JG,et al.3D printout models vs.3D-rendered images:which is better for preoperative planning?[J].J Surg Educ,2016,73(3):518-523.
[32]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会,中国图学学会医学图像与设备专业委员会,等.计算机辅助联合吲哚菁绿分子荧光影像技术在肝脏肿瘤诊断和手术导航中的应用专家共识[J].中国实用外科杂志,2017,37(5):531-538.
[33]Ankersmit M,van Dam DA,van Rijswijk AS,et al.Fluorescent imaging with indocyanine green during laparoscopic cholecystectomy in patients at increased risk of bile duct injury[J].Surg Innov,2017,24(3):245-252.
[34]Harada N,Ishizawa T,Muraoka A,et al.Fluorescence navigation hepatectomy by visualization of localized cholestasis from bile duct tumor infiltration[J].J Am Coll Surg,2010,210(6):e2-6.
[35]Tang R,Ma LF,Rong ZX,et al.Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery:A review of current methods[J].Hepatobiliary Pancreat Dis Int,2018,17(2):101-112.
[36]Vávra P,Roman J,Zon a P,et al.Recent Development of augmented reality in surgery:a review[J].J Healthc Eng,2017,2017:4574172.
[37]Pourmand A,Davis S,Lee D,et al.Emerging utility of virtual reality as a multidisciplinary tool in clinical medicine[J].Games Health J,2017,6(5):263.
[38]Nagendran M,Gurusamy KS,Aggarwal R,et al.Virtual reality training for surgical trainees in laparoscopic surgery[J].Cochrane Database Syst Rev,2013,(8):CD006575.
[2]孟翔飞,段伟东,王学栋,等.计算机3D技术研究围肝门部门静脉变异者胆管变异率[J].中国临床解剖学杂志,2016,34(2):155-159.
[3]Yang Y,Zhou Z,Liu R,et al.Application of 3D visualization and 3D printing technology on ERCP for patients with hilar cholangiocarcinoma[J].Exp Ther Med,2018,15(4):3259-3264.
[4]方驰华,蔡伟,范应方,等.从数字虚拟人到三维可视化肝脏3D打印[J].中国实用外科杂志,2016,36(1):47-50.
[5]莫志康,方驰华,项楠,等.三维可视化辅助3D腹腔镜、胆道硬镜肝胆管结石靶向碎石术并发症防治研究[J].中国实用外科杂志,2017,37(3):284-287.
[6]Sampogna G,Pugliese R,Elli M,et al.Routine clinical application of virtual reality in abdominal surgery[J].Minim Invasive Ther Allied Technol,2017,26(3):135-143.
[7]李斌,姜小清.“肝门”概念的解剖学发展及其临床意义[J].中华肝胆外科杂志,2018,24(7):433-436.
[8]孟翔飞,董家鸿,黄志强.围肝门部胆管临床解剖学研究进展[J].中华外科杂志,2010,48(13):1022-1026.
[9]中华医学会数字医学分会,中华医学会外科学分会胆道外科学组,中国研究型医院学会数字医学临床外科专业委员会.胆囊癌三维可视化诊治专家共识(2018版)[J].中国实用外科杂志,2018,38(12):1339-1346.
[10]王坚,闫加艳.围肝门外科技术在高位胆管损伤修复中的应用[J].外科理论与实践,2017,22(3):215-217.
[11]郑树国.腹腔镜技术在肝脏外科的拓展应用[J].中华消化外科杂志,2013,12(5):324-327.
[12]黄志强.今日胆道外科[J].中华实验外科杂志,2011,28(11):1827-1828.
[13]王坚.围肝门外科技术在复杂肝内胆管结石再手术中的应用[J].肝胆外科杂志,2017,25(3):161-163.
[14]顾奇云,赵军,周国庆,等.胆石症合并肝硬化门静脉高压症的治疗经验[J].中华普通外科杂志,2014,29(4):292-294.
[15]方驰华,方兆山,蔡伟,等.肝胆管结石三维可视化诊治平台构建及临床价值研究[J].中国实用外科杂志,2015,35(9):974-978.
[16]杨世忠.计算机辅助手术规划系统在肝门部胆管癌治疗中应用现状及展望[J].中国实用外科杂志,2013,33(1):47-50.
[17]林科灿,曾永毅,黎蕴通,等.三维重建虚拟手术规划在肝门部胆管癌手术中的应用价值[J].中华消化外科杂志,2018,17(4):383-388.
[18]Mansour JC,Aloia TA,Crane CH,et al.Hilar cholangiocarcinoma:expert consensus statement.[J].HPB,2015,17(8):691-699.
[19]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.复杂性肝脏肿瘤三维可视化精准诊治专家共识[J].中国实用外科杂志,2017,37(1):53-59.
[20]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.肝门部胆管癌三维可视化精准诊治专家共识[J].中国实用外科杂志,2017,37(1):48-52.
[21]Shimizu H,Hosokawa I,Ohtsuka M,et al.Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy[J].World J Surg,2014,38(12):3210-3214.
[22]曾宁,方驰华,范应方,等.肝门部胆管癌三维可视化精准诊疗平台构建及临床应用[J].中华外科杂志,2016,54(9):680-685.
[23]Zeng N,Tao H,Fang C,et al.Individualized preoperative planning using three-dimensional modeling for Bismuth and Corlette type III hilar cholangiocarcinoma[J].World J Surg Oncol,2016,14(1):44.
[24]Miyamoto R,Oshiro Y,Hashimoto S,et al.Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma[J].World J Gastroenterol,2014,20(32):11451-11455.
[25]Okuda Y,Taura K,Seo S,et al.Usefulness of operative planning based on 3-dimensional CT cholangiography for biliary malignancies[J].Surgery,2015,158(5):1261-1271.
[26]Zhang J,Qiao QL,Guo XC,et al.Application of three-dimensional visualization technique in preoperative planning of progressive hilar cholangiocarcinoma[J].Am J Transl Res,2018,10(6):1730-1735.
[27]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会.肝胆管结石三维可视化精准诊治专家共识[J].中国实用外科杂志,2017,37(1):60-66.
[28]方驰华,刘允怡.数字化胆道外科学[M].北京:人民卫生出版社,2018:207-208.
[29]武涛,张兴凯,范德增.3D生物打印技术及其外科临床应用[J].中国实用外科杂志,2015,35(5):570-572.
[30]方驰华,蔡伟,范应方,等.从数字虚拟人到三维可视化肝脏3D打印[J].中国实用外科杂志,2016,36(1):47-50.
[31]Zheng YX,Yu DF,Zhao JG,et al.3D printout models vs.3D-rendered images:which is better for preoperative planning?[J].J Surg Educ,2016,73(3):518-523.
[32]中华医学会数字医学分会,中国研究型医院学会数字医学临床外科专业委员会,中国图学学会医学图像与设备专业委员会,等.计算机辅助联合吲哚菁绿分子荧光影像技术在肝脏肿瘤诊断和手术导航中的应用专家共识[J].中国实用外科杂志,2017,37(5):531-538.
[33]Ankersmit M,van Dam DA,van Rijswijk AS,et al.Fluorescent imaging with indocyanine green during laparoscopic cholecystectomy in patients at increased risk of bile duct injury[J].Surg Innov,2017,24(3):245-252.
[34]Harada N,Ishizawa T,Muraoka A,et al.Fluorescence navigation hepatectomy by visualization of localized cholestasis from bile duct tumor infiltration[J].J Am Coll Surg,2010,210(6):e2-6.
[35]Tang R,Ma LF,Rong ZX,et al.Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery:A review of current methods[J].Hepatobiliary Pancreat Dis Int,2018,17(2):101-112.
[36]Vávra P,Roman J,Zon a P,et al.Recent Development of augmented reality in surgery:a review[J].J Healthc Eng,2017,2017:4574172.
[37]Pourmand A,Davis S,Lee D,et al.Emerging utility of virtual reality as a multidisciplinary tool in clinical medicine[J].Games Health J,2017,6(5):263.
[38]Nagendran M,Gurusamy KS,Aggarwal R,et al.Virtual reality training for surgical trainees in laparoscopic surgery[J].Cochrane Database Syst Rev,2013,(8):CD006575.
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