iPlan CMF软件辅助下增强CT三维重建在头颈部肿瘤治疗中的应用

doi:10.3969/j.issn.1671-167X.2017.05.024

摘要/Abstract

摘要： 目的应用iPlan CMF软件重建头颈部肿瘤患者增强CT影像中的肿物及周围重要解剖结构,探讨iPlan CMF指导下增强CT三维重建技术在头颈部肿瘤手术治疗中的临床意义。方法选取2014年6月至2015年6月就诊于北京大学口腔医学院口腔颌面外科的13例头颈部肿瘤紧邻重要神经、血管的患者,利用Seimens 16排螺旋CT薄层扫描技术,以额定扫描参数完成头颈部增强扫描,iPlan CMF软件直接读入Dicom格式原始数据,利用表面阴影重建法分别重建肿瘤、血管、骨骼及其他重要解剖结构,显示其术前三维空间关系,测量标记肿瘤与重要血管等解剖结构的距离,视肿瘤观察需要可行虚拟截骨,完成肿瘤暴露,设计手术入路,用以指导术前准备及手术。收集13例患者的术前准备、术中情况及术后并发症情况。结果 13例患者中,男6例,女7例,年龄23~65岁,中位年龄50岁。观察三维重建图像,可以清晰显示肿瘤范围、大小、位置及其与周围临近重要解剖结构的关系,根据三维重建图像,评估13例患者的手术风险,3例患者经过肿瘤三维重建等术前评估,建议综合治疗;10例患者完成术前准备并成功完成手术,其中3例患者术前备血及术中输血,2例患者邀请神经外科、胸外科协助手术,10例患者手术平均用时(202±135) min,手术平均出血(235±252) mL,三维标记与术中情况符合率为100%,其中1例患者由于肿瘤来源于迷走神经,术后出现声音嘶哑,其余患者未出现手术并发症。结论利用iPlan CMF软件三维重建增强CT可以清楚显示头颈部深大肿瘤的特征及其与周围重要解剖结构的关系,有利于手术方案的设计,避免术中损伤重要解剖结构,减少术后并发症的产生。

关键词: 头颈部肿瘤, 动态增强计算机断层扫描, 三维重建

Abstract: Objective: Three-dimensional reconstruction of the enhanced CT is increasingly becoming a valuable tool in head and neck neoplasms. The aim of this study is to reconstruct three-dimensional imaging of tumor and its surrounding important anatomical structure using iPlan CMF software, and to investigate the application of three-dimensional tumor mapping technique for the diagnosis and treatment of the head and neck neoplasms. Methods: In the study, 13 cases with head and neck tumors in Department of Oral and Maxilloficial Surgery, Peking University School and Hospital of Stomatology from June 2014 to June 2015 were studied using spiral CT scanning technology based on the same scanning condition. iPlan CMF software was used to read the original CT data, and surface shaded technology was applied to reconstruct the spatial relationship of the tumor, vessel and skull. The distance between the tumor and its surrounding important anatomical structure could be measured. iPlan CMF software was also used to accomplish the virtual osteotomy to expose the tumor, vessel and skull. The preoperative preparation, operative situation and postoperative complication were reviewed. Results: In this study 6 patients were male and 7 female. The age range was from 23 to 65 years, and the median patient age was 50 years. The three-dimensional reconstruction image clearly demonstrated the extent of the tumor size, location, and the relation to its surrounding important anatomical structure. According to the three-dimensional image, the surgical risk of the patients was evaluated. The preoperative preparation and surgeries were successfully performed for 10 patients. Blood transfusion for 3 patients was considered before the surgery and actually accomplished during the operation. The operations for 2 patients were performed with the help of doctors from other departments. Only one patient had hoarseness because the tumor resulted from the pneumogastric nerves. For 10 patients, the average operation time was (202±135) min, and the average operation bleeding was (235±252) mL. The other 3 patients were not suitable cases for surgery. Conclusion: The three-dimensional reconstruction of enhanced CT image with iPlan CMF software is very helpful to make the treatment plan to avoid damaging important anatomical structures and postoperative complications.

Key words: Head and neck neoplasms, Contrast-enhanced computed tomography, Three-dimensional reconstruction

中图分类号:

R782.05

于尧, 章文博, 王洋, 刘筱菁, 郭传瑸, 俞光岩, 彭歆. iPlan CMF软件辅助下增强CT三维重建在头颈部肿瘤治疗中的应用[J]. 北京大学学报(医学版), 2017, 49(5): 878-882.

YU Yao, ZHANG Wen-bo, WANG Yang, LIU Xiao-jing, GUO Chuan-bin, YU Guang-yan, PENG Xin. Application of three-dimensional reconstruction of the enhanced CT with iPlan CMF software in head and neck neoplasms[J]. Journal of Peking University(Health Sciences), 2017, 49(5): 878-882.

参考文献

[1] 孟庆玲, 韩卉, 张峰, 等. CT三维重建在侧颅底的应用研究[J]. 四川解剖学杂志, 2003, 11(2): 3-5.
[2] de Rosa V, Ionna F, Mozzillo N, et al. 3D spiral computerized tomography in the reconstructive treatment of malignant maxillofacial tumors[J]. Radiol Med, 2000, 100(6): 424-428.
[3] Kaur J, Chopra R. Three dimensional CT reconstruction for the evaluation and surgical planning of mid face fractures:a 100 case study[J]. J Maxillofac Oral Surg, 2010, 9(4): 323-328.
[4] Mevio E, Calabrò P, Preda L, et al. Spiral computerized tomography with tridimensional reconstruction (spiral 3D CT) in the study of maxillofacial pathology[J]. Acta Otorhinolaryngol Ital, 1995, 15(6): 443-448.
[5] Schubert W, Gear AJ, Lee C, et al. Incorporation of titanium mesh in orbital and midfacereconstruction[J]. Plast Reeonstr Surg, 2002, 110(4): 1022-1030.
[6] 李希平, 韩德民, 夏寅. 基于CT片的颞骨计算机三维重建及实体模型复制[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(4): 296-298.
[7] Gasparini FF, Navarro OM, Dasgupta R, et al. Ileocolic intussusception mimicking the imaging appearance of midgut volvulus as a result of extrinsic duodenal obstruction[J]. Pediatr Radiol, 2005, 35(12): 1246-1249.
[8] 郝凯飞, 张绍祥, 王斌全, 等. 中国数字化人体鼻部结构的三维重建和可视化[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 144-147.
[9] Yu Y, Zhang W, Wang Y, et al. A revised approach for mandi-bular reconstruction with the vascularized iliac crest flap using virtual surgical planning and surgical navigation [J]. J Oral Maxillofac Surg, 2016, 74(6): 1285.e1-1285.e11.
[10] Yu Y, Zhang W, Liu X, et al. Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap[J]. J Oral Maxillofac Surg, 2016,74(7): 1503.e1-1503.e10.
[11] Yu Y, Zhang W, Liu X, et al. A new procedure assisted by digi-tal techniques for secondary mandibular reconstruction with free fibula flap[J]. J Craniofac Surg, 2016, 27(8): 2009-2014.
[12] Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part Ⅰ. Algorithm and outcomes. [J]. PIastReconstr Surg, 2012, 129(1): 124-136.
[13] 刘杰, 徐震纲. 数字化及三维打印技术在颌骨恶性肿瘤术后复杂缺损重建中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(6): 473-476.
[14] 陈敏洁, 杨驰. 手术导航系统在颅颌面外科中的应用[J]. 中国口腔颌面外科杂志, 2007, 5(1): 70-72.
[15] Papadopoulos MA, Christou PK, Athanasiou AE, et al. Three-dimensional craniofacial reconstruction imaging[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002, 93(4): 382-393.
[16] 郭玉兴, 郭传瑸. 增强CT三维重建在颞下咽旁间隙肿瘤中的应用[J]. 北京大学学报(医学版), 2011, 43(1): 148-150.
[17] 章文博, 于尧, 王佃灿, 等. 三维标记技术在上颌骨恶性肿瘤外科治疗中的应用[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(5): 378-381.
[18] 郭玉兴, 郭传瑸. 导航技术在颅底-颞下区肿瘤手术中的应用[J]. 中华口腔医学杂志, 2013, 48(11): 645-647.

相关文章 12

[1]	唐祖南,Hui Yuh Soh,胡耒豪,于尧,章文博,彭歆. 混合现实技术在口腔颌面部肿瘤手术中的应用[J]. 北京大学学报（医学版）, 2020, 52(6): 1124-1129.
[2]	洪洪,钱宇婷,付磊,王武,李成辉,尹毅青. 困难气道中运用CT 三维重建技术指导硬质纤维气管镜行气管插管[J]. 北京大学学报（医学版）, 2019, 51(5): 870-874.
[3]	王晶,陈俊鹏,王洋,许向亮,郭传瑸. 数字化下颌运动记录及咀嚼肌肌电图在下颌骨肿瘤患者口颌功能评价中的应用[J]. 北京大学学报（医学版）, 2019, 51(3): 571-578.
[4]	陈素华,杨军,韩鸿宾,崔德华,孙建军,马长城,和清源,林国中,韩芸峰,吴超,马凯明,张一博. 弥散张量成像联合虚拟现实三维重建在功能区胶质瘤手术中的应用[J]. 北京大学学报（医学版）, 2019, 51(3): 530-535.
[5]	李健男，冯芝恩，王琳，王衣祥，郭传瑸. 乏氧诱导因子-1α在口腔鳞状细胞癌颈淋巴转移中的作用[J]. 北京大学学报(医学版), 2018, 50(1): 26-32.
[6]	王威，郑磊，刘树铭，黄明伟，石妍，吕晓鸣，张杰，张建国. 单纯放射性粒子治疗后的头颈部腺源性癌远处转移[J]. 北京大学学报(医学版), 2017, 49(3): 547-550.
[7]	赵一姣，王斯维，刘怡，王勇. 基于影像学牙周膜解剖特征快速提取活体牙三维牙根形态的方法[J]. 北京大学学报(医学版), 2017, 49(1): 54-059.
[8]	张杰, 郑磊, 刘树铭, 黄明伟, 高岩, 张祖燕, 张建国. 空心针穿刺活检在口腔颌面部肿瘤的应用[J]. 北京大学学报（医学版）, 2012, 44(5): 801-803.
[9]	江萍, 马月, 王俊杰, 冉维强, 姜玉良, 曲昂. 超声引导放射性¹²⁵I粒子植入治疗头颈部复发肿瘤[J]. 北京大学学报（医学版）, 2012, 44(2): 291-294.
[10]	马长城, 王振宇, 于涛. C1-2哑铃型肿瘤的手术治疗[J]. 北京大学学报（医学版）, 2011, 43(2): 301-303.
[11]	张杰, 郑磊, 黄明伟, 刘树铭, 贾凌飞, 石妍, 俞光岩, 张建国. 放射性粒子组织间植入治疗口腔颌面-头颈部腺源性恶性肿瘤近期疗效分析[J]. 北京大学学报（医学版）, 2011, 43(2): 272-275.
[12]	柳晓辉, 那加, 刘玲玲, 罗斌. 头颈部血管肉瘤3例[J]. 北京大学学报（医学版）, 2001, 33(3): 288-289.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed