增强现实技术在肝胆外科的应用

一、增强现实技术（VR）

VR技术是一种实时地计算摄影机影像的位置及角度并加上相应图像的技术，其目标是在屏幕上把虚拟世界套在现实世界并进行互动。VR技术包含了多媒体、三维建模、实时视频显示及控制、多传感器融合、实时跟踪及注册、场景融合等新技术与新手段。增强现实提供了在一般情况下，不同于人类可以感知的信息。

近年来，VR技术在医疗领域的应用越来越广泛。例如：使用VR技术和手持式扫描仪，向护士和医生展示患者身体中静脉的位置，帮助护士更容易找到静脉；利用VR技术创建肿瘤的标准三维图像，帮助外科医师做手术以及利用可穿戴的人工智能夹式相机能为盲人读取文本，描述对象，识别面孔等。可以肯定的是，未来VR/AR技术将为传统医疗健康产业的优化升级带来重要机遇。

二、本 文 简 介

精准肝胆外科手术的实践仍具有颇多挑战。而实现最大化目标病灶清除，最大化肝脏功能性体积保留以及最小化手术创伤侵袭是患者获得最佳康复的关键策略。以增强现实技术为代表的先进可视化技术可用于实时手术导航，能够提高外科干预的可控性和规避风险能力。本刊近期刊登的一篇来自北京清华长庚医院董家鸿院士团队的综述（引用：Tang R, Ma LF, Rong ZX, Li MD, Zeng JP, Wang XD, Liao HE, Dong JH. Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods. Hepatobiliary Pancreat Dis Int 2018;17:101-112. PMID: 29567047 doi: 10.1016/j.hbpd.2018.02.002.），作者通过检索了PubMed数据库中增强现实技术导航肝胆外科手术的相关文章，描述、分析并讨论了现有技术特点，临床实践情况和未来发展方向。

作者发现，增强现实技术主要由“三维重建技术”、“显示技术”、“追踪技术”和“配准技术”这四个子部分组成。在临床应用中，以基于视频合成的方式为主进行显示和导航，腹腔镜和开腹肝胆手术均有报道。通过将术前三维重建的肿瘤、肝内脉管结构与术中实时肝脏图像相叠加，使肝脏“透明化”，引导切割平面，实现手术导航，促进精准肝脏切除。术中肝脏的位移和形变则是造成导航偏差的主要原因。

作者认为应用增强现实技术能够提高肝胆外科手术的精准度，从而使病患获益。然而，对于实时、连续、精确的导航仍有待于技术的进步。增强现实技术所带来的病人预后改善仍需进一步的研究来验证。

Abstract

Background: Augmented reality (AR) technology is used to reconstruct three-dimensional (3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical outcomes.

Data Sources: The keywords “augmented reality”, “liver”, “laparoscopic” and “hepatectomy” were used for searching publications in the PubMed database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key articles.

Results: In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery, which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR technology.

Conclusions: With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling, and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods.

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在线投稿

https://mc03.manuscriptcentral.com/hbpdint

优先出版

https://www.sciencedirect.com/journal/hepatobiliary-and-pancreatic-diseases-international