仿真超声条件下肝肿瘤热消融治疗规划方法研究及验证

With the development of image-guided percutaneous thermal ablation, thermal ablation therapy has been one of the liver cancer radical methods. Due to the complexity of the liver organs and the limitations of conventional imaging guide, the clinical application of this technology, especially the popularization, faces greater problems. How to achieve the scientific, objective, convenient, individualized treatment planning is one of the key issues of the technology. Recently, domestic and foreign researchers are trying to apply three-dimensional surgical planning of liver surgery to the field of ablation therapy, but because of the different operation mode between the surgery and ablation, the direct application of three-dimensional surgical planning of liver surgery can not meet the needs of the image-guided percutaneous thermal ablation for liver tumors. The project is planned, on the basis of previous studies, for thermal ablation treatment of liver tumor characteristics and clinical needs of practical application, using simulation technology of ultrasound, three-dimensional image processing and analysis techniques and navigation technology, to achieve relatively scientific, objective, convenient, individual treatment planning methods and software systems for thermal ablation of liver tumors under the conditions of simulation ultrasound. The program is conducted from the following aspects : the algorithm of simulation ultrasound and the generation of simulation ultrasound images, the study of three-dimensional visualization model of thermal ablation of liver tumors and the optimal puncture path to meet clinical practice needs. The practicality of planning methods and software systems is verified through a series of experiments and ultimately benefit the patients with liver tumors.

随着影像引导下经皮热消融技术的发展，热消融治疗已成为肝癌根治性方法之一。由于肝脏器官的复杂性及常规影像引导技术的局限性使该项技术的临床应用，特别是普及推广面临较大问题。如何实现科学、客观、便捷、个体化的治疗规划是该技术面临的关键问题之一。近期国内外研究者尝试将肝脏外科三维手术规划方法应用于消融治疗领域，但由于两种治疗方法操作方式不同，直接应用肝脏外科三维手术规划方法不能满足影像引导下经皮热消融治疗肝肿瘤的需求。本项目拟在以往研究的基础上，针对热消融治疗肝肿瘤的特点和临床实际应用需求，利用仿真超声技术、三维影像处理和分析技术及导航技术，从仿真超声算法及仿真超声图像生成、肝肿瘤热消融三维模型研究及满足临床实际需求的最优化穿刺路径等方面入手，实现相对科学、客观、便捷、个体化的仿真超声条件下肝肿瘤热消融治疗规划方法及软件系统，并通过系列实验来验证该规划方法及软件系统的实用性，最终造福肝肿瘤患者。

随着影像引导下热消融技术的发展，热消融技术已成为肝癌根治性方法之一。手术规划是保证肿瘤原位适形消融的前提，传统的手术规划需要术者通过二维图像反复观察判断肿瘤与周围结构的位置关系，并在大脑中重建三维结构图像，但不同医生观察及空间重建能力不同，往往导致判断不准确以至于消融治疗失败或出现严重并发症。本课题为了解决影像引导下肝肿瘤热消融的科学、客观、便捷、个体化的治疗规划问题，针对影像引导下经皮热消融治疗肝脏肿瘤的临床实际应用需求，结合仿真超声技术方法、三维影像处理和分析方法及导航技术，重点研究了仿真超声算法及仿真超声图像生成、肝肿瘤热消融三维模型建立及最优化穿刺路径等关键技术，实现了仿真超声条件下三维可视化肝肿瘤热消融治疗规划方法及系统的建立。在该系统验证试验中，我们创新性地提出了利用临床真实数据的仿真模拟实验方法，真实模拟了患者临床术前治疗规划的环境，客观评价了仿真超声条件下术前三维可视化治疗规划系统的使用价值。试验结果分析得出无论对于有经验医生还是无经验医生，采用仿真超声三维可视化术前规划系统较采用二维超声下规划可以提高规划消融率，降低规划的周围结构损伤率；肿瘤最大直径大于25mm时，建议采用三维可视化术前规划系统进行规划。在此基础上我们进行了初步的临床应用，取得了较好的临床效果。该项目可促进影像引导下经皮热消融治疗技术的临床应用及推广，进而造福于肿瘤患者。