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目的探讨利用VTK实现三维可视化系统对胆囊管变异的诊断价值及临床意义。方法回顾性分析经临床确诊的160例胆石症患者,分别采用传统最大密度投影(MIP)及三维可视化系统辅助,对磁共振胰胆管水成像(MRCP)进行胆囊管变异的诊断,并与手术结果进行比较。结果以手术结果为金标准,在三维可视化系统辅助下检出胆囊管变异81例,与手术结果一致且差异无统计学意义(κ=0.950,P=1.000);而单纯采用MIP结合薄层图像检出则为51例,与手术结果存在差异且具有统计学意义(κ=0.477,P<0.001)。对难以明确诊断的39例胆囊管旋前或旋后汇入肝总管的变异,在三维可视化系统的辅助下分别检出12例及27例,与手术结果一致且差异无统计学意义(κ=0.880,P=1.000);而单纯采用MIP结合薄层图像则分别检出24例及15例,与手术结果的差异具有统计学意义(κ=0.246,P=0.004)。结论利用VTK实现的三维可视化系统可以提高对胆囊管变异诊断的准确性,不仅弥补了MIP对于空间比邻关系显示欠确切的不足,更有助于临床术前了解胆囊管解剖变异的情况,避免胆囊切除术中所引起的胆道损伤。
Objective To investigate the diagnostic value and clinical significance of cystic duct aberration using VTK system. Methods A retrospective analysis of 160 patients with clinically diagnosed cholelithiasis was performed. MRCP was used to diagnose cystic duct abnormalities by traditional maximum density projection (MIP) and three-dimensional visualization system respectively. The results were compared with the surgical findings Compare. Results Eighty-one cases of cystic duct abnormalities were detected with the help of 3D visualization system. The results were consistent with the surgical findings (χ = 0.950, P = 1.000). However, the simple combination of MIP with thin-layer images There were 51 cases detected, which were statistically different from the surgical findings (κ = 0.477, P <0.001). Thirty-nine patients with difficult diagnosis of cystic duct anterior and posterior hepatic duct were randomly divided into two groups: 12 cases and 27 cases were detected with the aid of 3D visualization system, respectively. The results were consistent with the surgical findings (P < 0.880, P = 1.000). However, there were 24 cases and 15 cases were detected by using MIP combined with thin-layer images respectively. The difference between them was statistically significant (κ = 0.246, P = 0.004). Conclusion The three-dimensional visualization system using VTK can improve the accuracy of the diagnosis of cystic duct changes, not only make up for the MIP lack of space for the relationship between the relative deficiencies, but also help to understand the anatomy of the cystic duct before surgery, to avoid gallbladder Biliary injury caused by resection.