智能肝脏手术:机遇与挑战
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摘要
在过去的几十年中,传统的医学诊疗模式得到了长足的发展,在手术过程中对于病变组织的判断往往依赖于肉眼所见以及术前影像学评估。然而,现有的二维影像技术不足以客观地反映某些器官例如肝脏的复杂解剖结构以及病变的详细形态特征,从而限制其在外科手术中的应用,影响手术切除疗效及预后。人工智能是一种以计算机作为运作载体,模拟人类完成行动目标的一类新型系统。近些年来,现代化人工智能医学技术具有精确诊断疾病、合理选择治疗方案、根治性切除病变组织以及规避手术风险等一系列优点,正在逐渐改变并且替代传统医学诊疗模式。本文阐述了最新有关于数字化诊疗技术在肝脏手术中的运用,并且为精准医疗在肝脏疾病领域中发挥作用提供了重要的技术平台。
引文
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[23]方驰华,刘允怡,周伟平.数字医学技术在中国普通外科应用的十年回顾[J].中华外科杂志,2017,55(12):887-890.
[24]中华医学会外科学分会胰腺外科学组,中国研究型医院学会胰腺疾病专业委员会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.胰头癌三维可视化精准诊治专家共识[J].中华外科杂志2017,55(12):881-886.
[2]Ng AC,Delgado V,van der Kley F,et al.Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2-and 3-dimensional transesophageal echocardiography and multislice computed tomography[J].Circ Cardiovasc Imaging,2010,3(1):94-102.
[3]Hahn RT,Khalique O,Williams MR,et al.Predicting paravalvular regurgitation following transcatheter valve replacement:utility of a novel method for three-dimensional echocardiographic measurements of the aortic annulus[J].J Am Soc Echocardiogr,2013,26(9):1043-1052.
[4]The Lancet.Artificial intelligence in global health:a brave new world[J].Lancet,2019,393(10180):1478.
[5]Marescaux J,Clement JM,Tassetti V,et al.Virtual reality applied to hepatic surgery simulation:the next revolution[J].Ann Surg,1998,228(5):627-634.
[6]Endo I,Matsuyama R,Taniguchi K,et al.Right hepatectomy with resection of caudate lobe and extrahepatic bile duct for hilar cholangiocarcinoma[J].J Hepatobiliary Pancreat Sci,2012,19(3):216-224.
[7]Simpson AL,Geller DA,Hemming AW,et al.Liver planning software accurately predicts postoperative liver volume and measures early regeneration[J].J Am Coll Surg,2014,219(2):199-207.
[8]Zhang G,Zhou XJ,Zhu CZ,et al.Usefulness of three-dimensional(3D)simulation software in hepatectomy for pediatric hepatoblastoma[J].Surg Oncol,2016,25(3):236-243.
[9]Satou S,Sugawara Y,Tamura S,et al.Three-dimensional computed tomography for planning donor hepatectomy[J].Transplant Proc,2007,39(1):145-149.
[10]Zein NN,Hanouneh IA,Bishop PD,et al.Three-dimensional print of a liver for preoperative planning in living donor liver transplantation[J].Liver Transpl,2013,19(12):1304-1310.
[11]Igami T,Nakamura Y,Hirose T,et al.Application of a threedimensional print of a liver in hepatectomy for small tumors invisible by intraoperative ultrasonography:preliminary experience[J].World J Surg,2014,38(12):3163-3166.
[12]Ikegami T,Maehara Y.Transplantation:3D printing of the liver in living donor liver transplantation[J].Nat Rev Gastroenterol Hepatol,2013,10(12):697-698.
[13]Glombitza G,Lamade W,Demiris A M,et al.Virtual planning of liver resections:image processing,visualization and volumetric evaluation[J].Int J Med Inform,1999,53(2-3):225-237.
[14]Chen X,Xu L,Wang Y,et al.Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display[J].J Biomed Inform,2015,55:124-131.
[15]Pessaux P,Diana M,Soler L,et al.Towards cybernetic surgery:robotic and augmented reality-assisted liver segmentectomy[J].Langenbecks Arch Surg,2015,400(3):381-385.
[16]Haouchine N,Dequidt J,Berger MO,et al.Deformationbased augmented reality for hepatic surgery[J].Stud Health Technol Inform,2013,184:182-188.
[17]He P,Huang T,Fang C,et al.Identification of extrahepatic metastasis of hepatocellular carcinoma using indocyanine green fluorescence imaging[J].Photodiagnosis Photodyn Ther,2019,25:417-420.
[18]Lim C,Vibert E,Azoulay D,et al.Indocyanine green fluorescence imaging in the surgical management of liver cancers:current facts and future implications[J].J Visc Surg,2014,151(2):117-124.
[19]Satou S,Ishizawa T,Masuda K,et al.Indocyanine green fluorescent imaging for detecting extrahepatic metastasis of hepatocellular carcinoma[J].J Gastroenterol,2013,48(10):1136-1143.
[20]Dilley JWR,Hughes Hallett A,Pratt PJ,et al.Perfect registration leads to imperfect performance:a randomized trial of multimodal intraoperative image guidance[J].Ann Surg,2019,269(2):236-242.
[21]Maier-Hein L,Tekbas A,Seitel A,et al.In vivo accuracy assessment of a needle-based navigation system for CT-guided radiofrequency ablation of the liver[J].Med Phys,2008,35(12):5385-5396.
[22]Fernandes AT,Apisarnthanarax S,Yin L,et al.Comparative assessment of liver tumor motion using cine-magnetic resonance imaging versus 4-dimensional computed tomography[J].Int J Radiat Oncol Biol Phys,2015,91(5):1034-1040.
[23]方驰华,刘允怡,周伟平.数字医学技术在中国普通外科应用的十年回顾[J].中华外科杂志,2017,55(12):887-890.
[24]中华医学会外科学分会胰腺外科学组,中国研究型医院学会胰腺疾病专业委员会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.胰头癌三维可视化精准诊治专家共识[J].中华外科杂志2017,55(12):881-886.