WO2019184158A1 - Method for preparing lung segment model quantified with inter-segmental marker - Google Patents

Method for preparing lung segment model quantified with inter-segmental marker Download PDF

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WO2019184158A1
WO2019184158A1 PCT/CN2018/096936 CN2018096936W WO2019184158A1 WO 2019184158 A1 WO2019184158 A1 WO 2019184158A1 CN 2018096936 W CN2018096936 W CN 2018096936W WO 2019184158 A1 WO2019184158 A1 WO 2019184158A1
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segment
lung
edge
junction
section
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PCT/CN2018/096936
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French (fr)
Chinese (zh)
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刘伦旭
徐昱扬
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四川大学华西医院
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides

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  • the invention relates to a method for determining an inter-segment landmark of a lung and a method for preparing a quantitative lung segment model.
  • the “lung expansion-frozen method” is usually used to determine the inter-segment plane: the target segment bronchus is clamped and the lungs are drummed, and the target segment bronchus is identified correctly; the target segment bronchus is cut off and the lung is again swelled. In the presence of inter-alveolar pores, the lung tissue of the target segment also swells.
  • the ventilation is stopped, and the lungs of the remaining lung segments are successively collapsed, while the lungs of the target segment are continuously inflated, and the relative boundary between the collapsed lung tissue and the inflated target segment lung tissue is determined. Plane and mark the lung surface with an electric knife.
  • the drawback of this method is that the terminal bronchioles may be in mutual communication, often resulting in poor collapse of the target lung segment and unclear flatness between the segments.
  • ICG indocyanine green
  • the present invention firstly provides a method for determining the inter-segment marker points of the lung, which can easily obtain the "digital segmentation point of the lung segment" of each person, thereby providing a
  • the method of preparing the lung segment model is to facilitate accurate segmental resection of the hospital at all levels.
  • the invention provides a method for determining the inter-segment landmarks of a lung, the steps are as follows:
  • CT lung chest venography and high-resolution thin-layer scanning were performed on the lungs to be examined; three-dimensional reconstruction of the original image was performed, and bronchial trees were generated according to the shape of the bronchi, leaf bronchus, segmental bronchi, sub-bronchus and terminal bronchioles.
  • the three-dimensional model is used to construct a three-dimensional lung segment image; and the boundary range of the lung segment image model generated based on the three-dimensional reconstruction of the bronchial tree is accurately defined by the path of the intervenous vein;
  • the method for determining the marker points between the segments of the lungs is as follows:
  • CT chest pulmonary vein angiography and high-resolution thin-layer scanning are performed on the lungs to be examined, and data between anatomical points, boundary lines and their connections on the surface of the lungs are measured;
  • step (1) the data of the anatomical structure recognizable on the surface of the lung is as follows:
  • the outer edge of the bottom edge the bottom edge of the left lower lobe is divided into two parts, namely the inner line of the bottom edge (medial side) and the outer line of the bottom edge (rib side), the front end is the intersection of the oblique crack and the bottom edge, and the rear end is the trailing edge. The intersection with the bottom edge.
  • the inner edge of the bottom edge the bottom edge of the right lower lobe is divided into two parts, namely the inner line of the bottom edge (medial side) and the outer line of the bottom edge (rib side), the front end is the intersection of the oblique fissure and the bottom edge, and the rear end is the mediastinum. The intersection of the front and the front.
  • step (2) the way to determine the position of the marker points between the segments is as follows:
  • intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection ;
  • the boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
  • the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • the anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment. 3/5 outside the junction of the junction;
  • the junction point between the leading edge of the leading edge and the front segment is located at the midpoint of the leading edge of the upper lobe;
  • the boundary point between the posterior edge and the tip segment is about the midpoint of the posterior edge of the upper lobe
  • the boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
  • the boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
  • the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • the anterior and posterior horn of the left lung the left upper lobe obliquely and the leading edge will be in the anterior inferior horn; the right anterior superior anterior horn: the right upper lobe horizontal fissure intersects the leading edge to form the anterior inferior horn.
  • the method for preparing a lung segment model of the present invention comprises the steps of: measuring data of an anatomical structure recognizable by the lung, preparing a lung model, and then installing each segment on the lung model according to the position of the marker points between the segments determined according to the foregoing method. Mark points.
  • the method of the invention can accurately determine the position of the marker points between the segments, so that the abstract inter-segment plane can be quantized, can guide the surgeon to perform precise segmentectomy, and further prepare the segment model for the surgeon to pre-operatively treat the lungs
  • the anatomical structure of the segment is clear at a glance and the application prospect is good.
  • Figure 1 shows the remaining identifiable anatomy of the lung surface
  • Figure 2 shows the lateral view of the left lung and the marker points between the upper segments of the left lung.
  • Figure 3 shows the marker points between the segments of the left lower lobe.
  • Figure 4 shows the lateral view of the right lung and the marker points between the upper segments of the right lung.
  • Figure 5 shows the marker points between the segments of the right lower lobe.
  • Figure 6 is a front elevational view showing the left lung segment of the left upper lobe and the right lung segment of the right upper lobe;
  • Figure 7 is a front elevational view showing the left lung segment of the left lower lobe in the present embodiment
  • Figure 8 is a rear elevational view of Figure 7;
  • Figure 9 is a right side view of Figure 7;
  • Figure 10 is a bottom view of Figure 7;
  • Figure 11 is a front elevational view of the right lung segment of the right lower lobe of the right lung;
  • Figure 12 is a rear elevational view of the right lower lobe of the present embodiment.
  • Figure 13 is a left side view of Figure 11;
  • Figure 14 is a right side view of Figure 11;
  • Figure 15 is a bottom view of Figure 11;
  • 1 is the posterior segment
  • 2 is the left anterior segment
  • 3 is the tongue segment
  • 4 is the left lung oblique fissure
  • 5 is the left lung lobe
  • 6 is the tip segment
  • 7 is the posterior segment
  • 8 is the right lung anterior segment.
  • 9 is the right middle lobe
  • 10 is the right lower lobe
  • 11 is the left lung dorsal segment
  • 12 is the left lung posterior basal segment
  • 13 is the left extrapulmonary basal segment
  • 14 is the anterior basal segment
  • 15 is the left lung oblique fissure and
  • 16 is the right lung dorsal segment
  • 17 is the anterior basal segment
  • 18 is the right extrapulmonary basal segment
  • 19 is the right posterior basal segment
  • 20 is the right lung basal segment
  • 21 is the right middle lobe
  • 22 is the transition of the right lung oblique fissure and the right lung mediastinum.
  • Example 1 Method for determining inter-segment landmarks of the lung of the present invention
  • the anatomical structures recognizable on the surface of the lung include the tip of the lung, the base of the lung, the rib surface on the outer side, the mediastinum on the medial side, and the leading edge, the trailing edge, and the lower edge.
  • the remaining anatomical structures of the left lung are: the posterior sloping cleft (the intersection of the oblique fissure and the trailing edge) (Fig. 1A); the anterior and posterior horn of the left upper lung (the intersection of the oblique fissure and the leading edge) (Fig. 1A); The anterior oblique lobes of the lower lobe and the transitional part of the mediastinum (Fig. 1B); the lower edge of the left lower lobe is divided into two parts, namely the medial line on the bottom edge (medial side) and the lateral line on the bottom edge (rib side), front end It is the rib side intersection of the oblique plane and the bottom edge (Fig. 1C), and the rear end is the intersection of the oblique plane and the mediastinum side of the bottom edge (Fig. 1C).
  • the remaining identifiable anatomical structures of the right lung are: the dorsal end of the oblique fissure (the intersection of the oblique fissure and the trailing edge) (Fig. 1D); the intersection of the horizontal fissure and the oblique fissure (Fig. 1D); the lower right anterior superior anterior horn (horizontal fissure and anterior The intersection of the margins (Fig. 1D); the transitional section of the anterior oblique lobe and the mediastinum of the right lower lobe pulmonary ligament (Fig. 1E); the right lower lobe is divided into two parts, the medial line of the inferior border (medial side) and The outer edge of the bottom edge (rib side) (Fig. 1F), the front end is the intersection of the oblique side and the rib side of the bottom edge, and the rear end is the intersection of the oblique plane and the mediastinal side of the bottom edge (Fig. 1F).
  • the length of the anatomical structure can be identified by measuring the leading edge or the like, and the inter-segment marking points are determined by the calculation scheme provided by the present invention.
  • the subject was subjected to CT chest venous venography + high-resolution thin-layer scanning (Simens SOMATOM Definition Flash CT), and the obtained original two-dimensional image was stored in the Digital Imaging and Communications in Medicine (DICOM) format.
  • DICOM Digital Imaging and Communications in Medicine
  • IQQA-3D Pre-operative Assessment and Treatment Plan Aid System for Thoracic Lungs developed by EDDA Technology and SOFTWARE (Shanghai) Co., Ltd. (provided by EDDA Technology)
  • the inter-segment mark The positional relationship of the point to the anatomical structure recognizable on the surface of the lung is measured.
  • the inter-segment markers of the lung segments of the upper left lobe are shown in Figure 2. Including: the boundary point between the front and the front of the leading edge; the boundary between the front and the tongue of the leading edge; the boundary between the rear and the tongue of the oblique tip; the intersection of the rear, front and tongue of the tip at the rib.
  • the measured data is: (1) the length of the leading edge; (2) the length of the oblique split.
  • intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection .
  • the inter-segmental markers of the lung segments of the left lower lobe are shown in Figure 3. Including: the boundary point between the oblique fractured segment and the anterior basal segment; the junction between the oblique segment and the medial segment of the mediastinum and the anterior basal segment (at the same level as the junction between the oblique segment and the anterior basal segment) Position); the junction point between the dorsal segment of the posterior margin of the left lower lung and the posterior basal segment; the intersection of the dorsal segment, the anterior inner segment and the outer base segment at the rib surface; the intersection of the dorsal segment, the outer base segment and the posterior base segment at the rib surface Point; the intersection of the back section, the front inner base section and the rear base section at the mediastinum; the boundary point between the inner base section and the outer basement section of the outer edge of the bottom edge; the boundary point between the outer basement section and the rear basement section of the outer edge of the bottom edge.
  • the measured data are: (1) the length of the trailing edge of the left lower lung; (2) the length of the lateral line of the bottom margin.
  • the boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
  • the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • the dorsal segment (here, the dorsal segment refers to the dorsal segment of the left lower lobe), the intersection of the anterior basal segment and the outer basal segment at the rib surface is located at the junction of the dorsal and posterior basal segments of the posterior margin and the oblique fissure The junction point between the back section and the front inner base section is at the first 3/10 of the line connecting the ribs;
  • the anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment.
  • the junction point is 3/5 outside the line.
  • the inter-segmental markers of the lung segments of the right upper lobe are shown in Figure 4. Including: the junction point of the leading edge and the front section; the junction point of the trailing edge and the rear section; the junction point of the front section and the back section of the horizontal section; the intersection point of the tip section, the back section and the front section at the rib surface.
  • the measured data are: (1) the length of the right upper lung leading edge; (2) the length of the right upper lung posterior margin; and (3) the length of the horizontal split.
  • junction point between the leading edge of the leading edge and the anterior segment is located at the midpoint of the leading edge of the right upper lung
  • the marker points between the segments of the right lower lobe are shown in Figure 5.
  • the method includes: a boundary point between the oblique split back section and the front basement section; a boundary point between the oblique split surface and the longitudinal section of the longitudinal partition portion and the inner basement section (at the same horizontal position as the boundary point between the oblique split back section and the front basement section); The intersection of the back section, the front base section and the outer base section at the rib surface; the intersection of the back section, the outer base section and the rear base section at the rib surface; the intersection of the back section, the inner base section and the rear base section at the mediastinum The intersection of the back section, the inner base section and the front section at the oblique plane; the junction of the trailing edge back section and the rear basement section; the boundary point between the basement section and the front basement section in the inner edge of the bottom edge; a junction point between the segment and the outer base segment; a boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge;
  • the measured data are: (1) the length of the oblique fissure; (2) the length of the posterior edge of the right lower lung; (3) the length of the inner line of the bottom edge; and (4) the length of the outer line of the bottom edge.
  • the boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
  • the junction between the posterior anterior and posterior basal segments is located at the upper 2/5 of the posterior border of the right lower lobe (where the posterior border of the lower lobe refers to the posterior border of the right lower lung);
  • the boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
  • the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
  • intersection of the dorsal segment, the anterior basal segment and the inner basal segment at the oblique plane is located at the junction of the oblique cleft segment and the anterior basal segment and the boundary between the oblique segment and the medial segment of the mediastinum (ie, at the midpoint of the line connecting the oblique plane and the mediastinum, at a point parallel to the position of the point (1) (ie, the point of intersection of the oblique fracture back and the anterior basement);
  • the above method was used to determine the ratio of the length between the inter-segment marking points of each lung segment to the length of the anatomical structure of the lung surface according to gender, age, body weight and height. There was no statistical difference between the groups, indicating the proportional length determined by the present invention. The consistency among different individuals is very good, and it can reflect the true position of the marker points between the segments, and can be widely used in different patients.
  • the reconstruction of the pulmonary vein was added during the three-micro reconstruction. It is known that the inter-segmental veins are shaped between the lung segments. Therefore, according to the shape of the inter-segmental vein, the accuracy of the size of the lung segment can be confirmed, thereby indirectly verifying the lung segment. The accuracy of the marker points.
  • a lung model was prepared according to the data of the lung recognizable anatomy of each patient measured in Example 1, and then the inter-segment marker points were installed on the lung model according to the position of the inter-segment marker points determined by the method of Example 1.
  • the lung segment model prepared by the method of the present invention is as follows:
  • the left lung segment includes: a left lung upper lobe, a left lung lobe, a left lung rib surface, a left lung mediastinum; the left lung lobe and The junction of the left lower lobe is a left lung oblique fissure;
  • the left lobe upper lobe includes: a posterior segment of the left lung, a anterior segment of the left lung, and a segment of the tongue;
  • the lower lobe of the left lung includes: a segment of the left lung, a anterior basal segment, and a left Extrapulmonary basal segment, left posterior basal segment;
  • said right segment includes: right upper lobe, right middle lobe, right lower lobe, right lung rib, right lung mediastinum; right lung upper lobe and right
  • the junction of the middle lobe of the lung is a horizontal split of the right lung;
  • the junction of the right middle lobe and the right lower lobe is a right lung ob
  • the method further includes: an inter-segment mark point;
  • the inter-segment marking points include:
  • a junction between the posterior segment of the tip and the anterior segment of the left lung at the anterior border of the left lung; the junction of the anterior segment of the left lung and the lingual segment at the anterior border of the left lung; the posterior segment of the tip, the anterior segment of the left lung, and the segment of the tongue are a junction point of the left lung rib surface; the tip posterior segment and the tongue segment at the junction of the left lung oblique fissure;
  • the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure a junction of the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure; the right lung dorsal segment, the anterior basal segment, and the right extrapulmonary basal segment at a junction of the right pulmonary rib surface; a junction of the right lung dorsal segment, the right extrapulmonary basal segment, and the right posterior pulmonary basal segment at the right lung rib surface; the right lung dorsal segment and the right pulmonary basal segment in the right lung oblique fissure and the right lung mediastinum a junction point of the facial transition portion; a junction of the right lung dorsal segment, the right pulmonary basal segment, and the right posterior pulmonary basal segment at the right lung rib surface; the right lung dorsal segment and the right lung posterior basal segment at the right a junction point of the posterior lung; the right anterior segment, the anterior basal segment, and the right lung
  • the junction of the posterior anterior segment and the left anterior segment at the left lung anterior border is located at the upper 1/5 of the left lung anterior border; the left lung anterior segment and the tongue segment are located at the junction of the left pulmonary anterior border The upper 3/5 of the left lung leading edge; the tip posterior segment and the tongue segment at the junction of the left lung oblique fissure are the first junction point, and the left lung anterior segment and the tongue segment are at the left lung leading edge
  • the junction point is a second junction point, and the intersection point of the tip posterior segment, the left lung anterior segment, and the tongue segment at the left lung rib surface is located at the intersection of the first junction point and the second junction point.
  • the tip posterior segment and the tongue segment are located at the upper 2/5 of the left lung oblique fissure at the junction of the left lung oblique fissure;
  • the left lung dorsal segment and the anterior basal segment at the junction of the left lung oblique fissure are located at the upper 2/5 of the left lung oblique fissure; the left lung dorsal segment and the left posterior basal segment in the left lung
  • the junction of the posterior margin is located at the midpoint of the posterior edge of the left lung; the junction of the anterior basal segment and the posterior ligament of the left lung at the lateral line of the left lung rim is located within the lateral line of the left lung margin 10;
  • the junction between the anterior basal segment and the left extrapulmonary basal segment at the lateral line of the left lung rim is located at the outer 1/4 of the lateral line of the left lung rim; the left extrapulmonary basal segment and the left
  • the junction point of the posterior lung basal segment at the lateral line of the left lung bottom edge is located at the midpoint of the lateral line of the left lung bottom edge; the junction between the left lung dorsal segment and the left posterior basal segment at the posterior border of the left lung
  • the junction between the tip segment and the right lung anterior segment at the right lung anterior border is located at a midpoint of the left lung anterior border; the right lung anterior segment and the posterior segment at the junction of the right lung horizontal fissure are located at the right lung level
  • the first 4/5 of the split; the posterior segment of the right lung and the anterior segment of the right lung at the posterior border of the right lung are located at the midpoint of the posterior margin of the right lung; the tip, the posterior, and the right lung are in the right lung
  • the intersection of the rib surface and the junction of the right lung anterior segment and the posterior segment at the junction of the right lung horizontal fissure, and the angle of the right lung horizontal fissure is 90 degrees;
  • the boundary between the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure is located at the upper 2/5 of the right lung oblique fissure; the right lung dorsal segment and the right posterior pulmonary basal segment are behind the right lung
  • the junction of the rim is located at the upper 2/5 of the posterior edge of the right lung; the junction of the anterior basal segment and the basal segment of the right lung at the bottom line of the right lung is located at the bottom line of the right lung
  • the midpoint of the right lung and the posterior lung basal segment at the lateral line of the right lung bottom edge are located at 1/10 of the outer line of the right lung bottom edge; the anterior basement segment a junction point of the right extrapulmonary basal segment at the lateral line of the right lung bottom edge is located at 1/4 of the lateral line of the right lung bottom edge; the right extrapulmonary basal segment and the right posterior basal segment are in the right lung a junction point of the lateral line of the bottom edge is located at a midpoint of
  • the lung segment model prepared by the method of the invention simulates the real left and right lung segments of the human body, installs inter-segment landmarks on the lung segment model, and precisely defines the position of the marker points between the segments, so that the abstract inter-segment plane can be Quantification allows the surgeon to see the anatomy of the lung segment at a glance before surgery, thus guiding the surgeon to perform accurate segmentectomy.
  • the detachable connection between the various lung segments of the model makes the anatomical relationship between the various lung segments clearer, further satisfying the needs of doctors' teaching and research.

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Abstract

A method for determining an inter-segmental marker of a lung and a method for preparing a quantified lung segment model. The method for determining an inter-segmental marker comprises steps of: (1) performing CT chest venous venography and high-resolution thin-layer scanning on a lung under examination; and performing three-dimensional reconstruction and other operations on an original image; and (2) determining an identifiable anatomical structure marker and a boundary line on the surface of the lung, and using the structures as reference points to measure a relative positional relationship between an inter-segmental position of each lung segment on the lung surface and the identifiable lung anatomical structure marker, calculating a length proportion thereof on an anatomical marking line by means of big data, so as to determine the position of an inter-segmental marker. The method is adopted to enable accurate determination of the positions of inter-segmental markers, and to quantify abstract inter-segmental planes in order to guide a surgeon to perform accurate segmentectomy. A lung segment model is further prepared, such that the surgeon can easily observe the anatomical structure of lung segments before surgery. The invention has potential for widespread application.

Description

一种段间标志点量化的肺段模型的制备方法Method for preparing lung segment model with quantification of inter-segment landmarks 技术领域Technical field
本发明涉及一种肺的段间标志点的确定方法以及量化肺段模型的制备方法。The invention relates to a method for determining an inter-segment landmark of a lung and a method for preparing a quantitative lung segment model.
背景技术Background technique
近年来，随着人们健康意识的进步和低剂量CT(LDCT)肺癌筛查的普及，早期“小肺癌”的检出率逐渐提高。在肺癌的治疗日趋精准化的大背景下，肺段切除日趋广泛地被应用于肺癌手术中，而最大限度地保存患者的正常肺组织，减少手术创伤成为外科手术追求的目标。In recent years, with the advancement of people's health awareness and the popularity of low-dose CT (LDCT) lung cancer screening, the detection rate of early "small lung cancer" has gradually increased. In the context of the increasingly precise treatment of lung cancer, segmentectomy has been widely used in lung cancer surgery, and maximally preserve the patient's normal lung tissue and reduce surgical trauma has become the goal of surgery.
然而，解剖性肺段切除仍然存在技术上的难点：由于各个肺段之间缺少解剖性标志，肺段切除的范围很难确定。目前临床中，通常采用“肺膨胀-萎陷法”确定段间平面：将靶段支气管夹闭后鼓肺，确定靶段支气管辨认正确；将靶段支气管切断后再次鼓肺，此时，由于肺泡间孔的存在，靶段肺组织也膨胀。当靶段肺所在肺叶膨胀后停止通气，其余肺段肺相继萎陷，而靶段肺则持续充气，萎陷的肺组织与充气的靶段肺组织之间形成相对界限，由此判断段间平面，并用电刀在肺表面进行标记。这种方法的缺陷在于，由于终末细支气管可能存在相互交通，常常导致靶肺段塌陷不好而使段间平面显示不清。However, there are still technical difficulties in anatomical segmental resection: the extent of segmental resection is difficult to determine due to the lack of anatomical landmarks between the various segments. At present, in the clinical practice, the “lung expansion-frozen method” is usually used to determine the inter-segment plane: the target segment bronchus is clamped and the lungs are drummed, and the target segment bronchus is identified correctly; the target segment bronchus is cut off and the lung is again swelled. In the presence of inter-alveolar pores, the lung tissue of the target segment also swells. When the lobe of the target lung is expanded, the ventilation is stopped, and the lungs of the remaining lung segments are successively collapsed, while the lungs of the target segment are continuously inflated, and the relative boundary between the collapsed lung tissue and the inflated target segment lung tissue is determined. Plane and mark the lung surface with an electric knife. The drawback of this method is that the terminal bronchioles may be in mutual communication, often resulting in poor collapse of the target lung segment and unclear flatness between the segments.
此外，也有学者报道了在靶段动脉结扎后静注靛青绿(indocyanine green,ICG)，在红外线胸腔镜(infrared thoracoscopy)下确定段间平面的技术。这种方法虽然较为准确，但由于操作流程较为繁琐，且对设备的要求较高，所以目前并没能在各级医院普遍开展。In addition, some scholars have reported the technique of injecting indocyanine green (ICG) after arterial ligation of the target segment and determining the interplanar plane under infrared thoracoscopy. Although this method is more accurate, it is not widely available in hospitals at all levels because of the cumbersome operation process and high requirements for equipment.
发明内容Summary of the invention
为了解决上述问题，更加准确的确定段间平面，本发明首先提供了一种肺的段间标志点的确定方法，可以简便地获得每个人的“肺段数字化标志点”，进而提供了一种制备肺段 模型的方法，以有利于各级医院的精准肺段切除。In order to solve the above problem and determine the inter-segment plane more accurately, the present invention firstly provides a method for determining the inter-segment marker points of the lung, which can easily obtain the "digital segmentation point of the lung segment" of each person, thereby providing a The method of preparing the lung segment model is to facilitate accurate segmental resection of the hospital at all levels.
本发明提供了一种肺的段间标志点的确定方法，步骤如下：The invention provides a method for determining the inter-segment landmarks of a lung, the steps are as follows:
(1)对待检的肺进行CT胸部肺静脉造影加高分辨薄层扫描；对原始图像进行三维重建，根据支气管、叶支气管、段支气管、亚段支气管及终末细支气管的走形生成支气管树的三维模型，并以此为依据构建三维肺段影像；同时通过段间静脉的路径，对基于支气管树三维重建生成的肺段影像模型的边界范围进行准确界定；(1) CT lung chest venography and high-resolution thin-layer scanning were performed on the lungs to be examined; three-dimensional reconstruction of the original image was performed, and bronchial trees were generated according to the shape of the bronchi, leaf bronchus, segmental bronchi, sub-bronchus and terminal bronchioles. The three-dimensional model is used to construct a three-dimensional lung segment image; and the boundary range of the lung segment image model generated based on the three-dimensional reconstruction of the bronchial tree is accurately defined by the path of the intervenous vein;
(2)确定肺表面可识别的解剖结构点及边界线，并以这些结构及他们之间的交叉点或交线作为参照，对肺表面各肺段的段间位置与上述可识别的肺部解剖结构标志的相对位置关系进行测量，并大数据计算其所在解剖标志线上的长度比例，来确定段间标志点的位置。(2) Determining the anatomical points and boundary lines recognizable on the surface of the lung, and using these structures and their intersections or intersections as a reference, the inter-segment position of each lung segment on the lung surface and the above-identifiable lungs The relative positional relationship of the anatomical landmarks is measured, and the ratio of the length of the anatomical landmark line on the anatomical landmark is calculated to determine the position of the marker points between the segments.
肺的段间标志点的确定方法，步骤如下：The method for determining the marker points between the segments of the lungs is as follows:
(1)对待检的肺进行CT胸部肺静脉造影和高分辨薄层扫描，测量肺表面可识别的解剖结构点、边界线及其连线之间的数据；(1) CT chest pulmonary vein angiography and high-resolution thin-layer scanning are performed on the lungs to be examined, and data between anatomical points, boundary lines and their connections on the surface of the lungs are measured;
(2)根据肺表面可识别的解剖结构的数据，确定段间标志点的位置。(2) Determine the position of the marker points between the segments based on the data of the anatomical structures recognizable on the surface of the lungs.
步骤(1)中，所述肺表面可识别的解剖结构的数据如下：In step (1), the data of the anatomical structure recognizable on the surface of the lung is as follows:
(一)左上肺(1) Left upper lung
(1)左上肺前缘的长度；(2)左上肺后缘的长度；(3)斜裂的长度；(1) the length of the left superior lung leading edge; (2) the length of the left upper lung posterior margin; (3) the length of the oblique fissure;
(二)左下肺：(2) Left lower lung:
(1)左下肺后缘的长度；(2)底缘外侧线的长度；(3)底缘内侧线的长度；(1) the length of the posterior edge of the left lower lung; (2) the length of the outer line of the bottom edge; (3) the length of the inner line of the bottom edge;
(三)右上肺：(3) Right upper lung:
(1)右上肺前缘的长度；(2)右上肺后缘的长度；(3)水平裂的长度；(1) the length of the anterior border of the right upper lung; (2) the length of the posterior border of the right upper lung; (3) the length of the horizontal split;
(四)右下肺：(4) Right lower lung:
(1)斜裂的长度；(2)右下肺后缘的长度；(3)底缘内侧线的长度；(4)底缘外侧线的长度。(1) the length of the oblique fissure; (2) the length of the posterior edge of the right lower lung; (3) the length of the inner line of the bottom edge; and (4) the length of the outer line of the bottom edge.
底缘外侧线：左肺下叶底缘分为两部分，即底缘内侧线(纵隔侧)及底缘外侧线(肋面侧)，前端为斜裂与底缘的交点，后端为后缘与底缘的交点。The outer edge of the bottom edge: the bottom edge of the left lower lobe is divided into two parts, namely the inner line of the bottom edge (medial side) and the outer line of the bottom edge (rib side), the front end is the intersection of the oblique crack and the bottom edge, and the rear end is the trailing edge. The intersection with the bottom edge.
底缘内侧线：右肺下叶底缘分为两部分，即底缘内侧线(纵隔侧)及底缘外侧线(肋面侧)，前端为斜裂与底缘的交点，后端为纵隔面、前面及膈面的交点。The inner edge of the bottom edge: the bottom edge of the right lower lobe is divided into two parts, namely the inner line of the bottom edge (medial side) and the outer line of the bottom edge (rib side), the front end is the intersection of the oblique fissure and the bottom edge, and the rear end is the mediastinum. The intersection of the front and the front.
步骤(2)中，确定段间标志点的位置的方式如下：In step (2), the way to determine the position of the marker points between the segments is as follows:
(一)左上肺：(1) Upper left lung:
(1)前缘尖后段与前段的交界点位于前缘的上1/5处；(1) The junction of the trailing edge of the leading edge and the front section is located at the upper 1/5 of the leading edge;
(2)前缘前段与舌段的交界点位于前缘的上3/5处；(2) The boundary point between the front edge of the leading edge and the tongue segment is located at the upper 3/5 of the leading edge;
(3)斜裂尖后段与舌段的交界点位于斜裂的上2/5处；(3) The boundary point between the posterior segment of the oblique fissure and the tongue segment is located at the upper 2/5 of the oblique fissure;
(4)尖后段、前段及舌段在肋面的交汇点位于斜裂尖后段与舌段的交界点与前缘前段与舌段的交界点在肋面连线的后1/5处；(4) The intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection ;
(二)左下肺：(2) Left lower lung:
(1)斜裂背段与前内基底段的交界点位于斜裂的上2/5处；(1) The boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
(2)后缘背段与后基底段的交界点位于下叶后缘的中点处；(2) the boundary point between the back edge of the trailing edge and the rear basement segment is located at the midpoint of the trailing edge of the lower blade;
(3)底缘外侧线前内基底段与后基底段的交界点位于底缘外侧线的内1/10处；(3) The boundary point between the inner base segment and the rear base segment of the outer edge of the bottom edge is located at 1/10 of the outer line of the bottom edge;
(4)底缘外侧线内基底段与外基底段的交界点位于底缘外侧线的外1/4处；(4) the boundary point between the base segment and the outer base segment in the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
(5)底缘外侧线外基底段与后基底段的交界点位于底缘外侧线的中点处；(5) the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
(6)背段、前内基底段及外基底段在肋面的交汇点位于后缘背段与后基底段的交界点和斜裂背段与前内基底段的交界点在肋面连线的前3/10处；(6) The intersection of the back section, the front inner base section and the outer base section at the rib surface is located at the junction of the trailing edge back section and the rear base section and the junction of the oblique split back section and the front inner base section on the rib surface The first 3/10 places;
(7)背段、外基底段及后基底段在肋面的交汇点位于后缘背段与后基底段的交界点 和斜裂背段与前内基底段的交界点在肋面连线的后1/10处；(7) The intersection of the back section, the outer base section and the rear base section at the rib surface is located at the junction of the back edge of the trailing edge and the rear basement section and the junction of the oblique split back section and the front inner basement section is connected at the rib surface. After 1/10;
(8)背段、前内基底段及后基底段在纵隔面的交汇点位于后缘背段与后基底段的交界点和斜裂面与纵隔面移行部背段与前内基底段的交界点连线的前1/5处；(8) The intersection of the dorsal segment, the anterior inner base segment and the posterior basement segment at the mediastinum is located at the junction of the posterior anterior and posterior basal segments and the boundary between the oblique and longitudinal medial segment and the anterior medial segment The first 1/5 of the point connection;
(9)前内基底段、外基底段及后基底段的在肺底交汇点位于底缘外侧线前内基底段与后基底段的交界点和底缘外侧线前内基底段与外基底段的交界点连线的外3/5处；(9) The anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment. 3/5 outside the junction of the junction;
(三)右上肺：(3) Right upper lung:
(1)前缘尖段与前段的交界点位于上叶前缘的中点处；(1) the junction point between the leading edge of the leading edge and the front segment is located at the midpoint of the leading edge of the upper lobe;
(2)水平裂前段与后段的交界点位于水平裂的前4/5处；(2) The junction between the front and rear sections of the horizontal split is located at the first 4/5 of the horizontal split;
(3)后缘后段与尖段的交界点约于上叶后缘的中点处；(3) the boundary point between the posterior edge and the tip segment is about the midpoint of the posterior edge of the upper lobe;
(4)尖段、后段及前段在肋面的交汇点与水平裂前段与后段的交界点的连线与水平裂的夹角为90度；(4) The angle between the intersection of the tip section, the back section and the front section at the intersection of the rib surface and the junction of the front section and the back section of the horizontal section is 90 degrees with the horizontal crack;
(四)右下肺：(4) Right lower lung:
(1)斜裂背段与前基底段的交界点位于斜裂的上2/5处；(1) The boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
(2)后缘背段与后基底段的交界点位于下叶后缘的上2/5处；(2) the boundary point between the back edge of the trailing edge and the rear basement segment is located at the upper 2/5 of the trailing edge of the lower blade;
(3)底缘内侧线前基底段与内基底段的交界点位于底缘内侧线的中点处；(3) the boundary point between the front base segment and the inner base segment of the inner edge of the bottom edge is located at the midpoint of the inner line of the bottom edge;
(4)底缘外侧线内基底段与后基底段的交界点位于底缘外侧线的内1/10处；(4) the boundary point between the base segment and the rear basement segment in the outer edge of the bottom edge is located at 1/10 of the outer line of the bottom edge;
(5)底缘外侧线前基底段与外基底段的交界点位于底缘外侧线的外1/4处；(5) The boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
(6)底缘外侧线外基底段与后基底段的交界点位于底缘外侧线的中点处；(6) the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
(7)背段、前基底段及外基底段在肋面的交汇点位于后缘背段与后基底段的交界点与斜裂背段与前基底段的交界点在肋面连线的约前3/10处；(7) The intersection of the back section, the front base section and the outer base section at the rib surface is located at the junction of the trailing edge back section and the rear basement section and the junction of the oblique split back section and the front basement section at the rib surface connection The first 3/10 places;
(8)背段、外基底段及后基底段在肋面的交汇点与后缘背段与后基底段的交界点重合；(8) the intersection of the back section, the outer base section and the rear base section at the rib surface coincides with the junction of the trailing edge back section and the rear base section;
(9)背段、前基底段及内基底段在斜裂面的交汇点位于斜裂背段与前基底段的交界点和斜裂面与纵隔面移行部背段与内基底段的交界点的连线的约前中点处；(9) The intersection of the dorsal segment, the anterior basal segment and the inner basal segment at the oblique plane is located at the junction of the oblique cleft segment and the anterior basal segment and the boundary between the oblique segment and the medial segment of the mediastinum At the midpoint of the connection;
(10)背段、内基底段及后基底段在纵隔面的交汇点位于后缘背段与后基底段的交界点和斜裂面与纵隔面移行部背段与内基底段的交界点连线的约前1/5处；(10) The intersection of the back section, the inner base section and the rear basement section at the mediastinum is located at the junction of the posterior anterior and posterior basal segments and the junction of the oblique and the mediastinum and the medial segment of the mediastinum About 1/5 of the line;
(11)内基底段、前基底段、外基底段及后基底段在肺底的交汇点与底缘外侧线前基底段与外基底段的交界点的连线与底缘外侧线的夹角为90度；(11) The angle between the line connecting the inner base segment, the anterior base segment, the outer base segment and the posterior base segment at the junction of the lung base and the boundary between the anterior base segment and the outer base segment of the outer edge of the bottom edge and the outer edge of the bottom edge At 90 degrees;
(12)内基底段、前基底段、外基底段及后基底段在肺底的交汇点与底缘内侧线内基底段与前基底段的交界点的连线与底缘内侧线的夹角为90度。(12) The angle between the line connecting the inner base segment, the anterior base segment, the outer base segment and the posterior base segment at the junction of the lung base and the boundary between the base segment and the anterior base segment at the inner edge of the bottom edge and the inner line of the bottom edge It is 90 degrees.
左肺前下角：左肺上叶斜裂与前缘会于前下角；右肺前下角：右肺上叶水平裂与前缘相交形成前下角。The anterior and posterior horn of the left lung: the left upper lobe obliquely and the leading edge will be in the anterior inferior horn; the right anterior superior anterior horn: the right upper lobe horizontal fissure intersects the leading edge to form the anterior inferior horn.
本发明一种肺段模型的制备方法，步骤如下：测量肺可识别的解剖结构的数据，制备肺模型，然后根据前述方法确定的段间标志点的位置，在肺模型上安装每个段间标志点。The method for preparing a lung segment model of the present invention comprises the steps of: measuring data of an anatomical structure recognizable by the lung, preparing a lung model, and then installing each segment on the lung model according to the position of the marker points between the segments determined according to the foregoing method. Mark points.
本发明方法可以精确地确定各个段间标志点的位置，使抽象的段间平面可量化，可以指导手术医生进行精准的肺段切除，进一步制备的肺段模型使得外科手术医生在术前对于肺段的解剖结构一目了然，应用前景良好。The method of the invention can accurately determine the position of the marker points between the segments, so that the abstract inter-segment plane can be quantized, can guide the surgeon to perform precise segmentectomy, and further prepare the segment model for the surgeon to pre-operatively treat the lungs The anatomical structure of the segment is clear at a glance and the application prospect is good.
显然，根据本发明的上述内容，按照本领域的普通技术知识和惯用手段，在不脱离本发明上述基本技术思想前提下，还可以做出其它多种形式的修改、替换或变更。It is apparent that various other modifications, substitutions and changes can be made in the form of the above-described embodiments of the present invention.
以下通过实施例形式的具体实施方式，对本发明的上述内容再作进一步的详细说明。但不应将此理解为本发明上述主题的范围仅限于以下的实例。凡基于本发明上述内容所实现的技术均属于本发明的范围。The above content of the present invention will be further described in detail below by way of specific embodiments in the form of embodiments. However, the scope of the above-mentioned subject matter of the present invention should not be construed as being limited to the following examples. Any technique implemented based on the above description of the present invention is within the scope of the present invention.
附图说明DRAWINGS
图1为肺表面其余可识别的解剖结构Figure 1 shows the remaining identifiable anatomy of the lung surface
图2为左肺外侧面观及左肺上叶各段间标志点Figure 2 shows the lateral view of the left lung and the marker points between the upper segments of the left lung.
图3为左肺下叶各段间标志点。A左肺外侧面观；B左肺内侧面观；C左肺后面观；D左肺底面观Figure 3 shows the marker points between the segments of the left lower lobe. A left lateral view of the left lung; B left lateral view of the lung; C left lung view; D left lung view
图4为右肺外侧面观及右肺上叶各段间标志点Figure 4 shows the lateral view of the right lung and the marker points between the upper segments of the right lung.
图5为右肺下叶各段间标志点。A右肺外侧面观；B右肺内侧面观；C右肺后面观；D右肺前面观；E右肺底面观Figure 5 shows the marker points between the segments of the right lower lobe. A right lateral view of the right lung; B right lateral view of the lung; C right back view; D right lung front view; E right lung bottom view
图6为本实施例中标明了左肺上叶的左肺段和标明了右肺上叶的右肺段的主视图；Figure 6 is a front elevational view showing the left lung segment of the left upper lobe and the right lung segment of the right upper lobe;
图7为本实施例中标明了左肺下叶的左肺段的主视图；Figure 7 is a front elevational view showing the left lung segment of the left lower lobe in the present embodiment;
图8为图7的后视图；Figure 8 is a rear elevational view of Figure 7;
图9为图7的右视图；Figure 9 is a right side view of Figure 7;
图10为图7的仰视图；Figure 10 is a bottom view of Figure 7;
图11为本实施例中标明了右肺下叶的右肺段的主视图；Figure 11 is a front elevational view of the right lung segment of the right lower lobe of the right lung;
图12为本实施例中右肺下叶的后视图；Figure 12 is a rear elevational view of the right lower lobe of the present embodiment;
图13为图11的左视图；Figure 13 is a left side view of Figure 11;
图14为图11的右视图；Figure 14 is a right side view of Figure 11;
图15为图11的仰视图；Figure 15 is a bottom view of Figure 11;
图中，1为尖后段，2为左肺前段，3为舌段，4为左肺斜裂，5为左肺下叶，6为尖段，7为后段，8为右肺前段，9为右肺中叶，10为右肺下叶，11为左肺背段，12为左肺后基底段，13为左肺外基底段，14为前内基底段，15为左肺斜裂与左肺纵隔面的移行部，16为右肺背段，17为前基底段，18为右肺外基底段，19为右肺后基底段，20为右肺内基底段，21为右肺中叶，22为右肺斜裂与右肺纵隔面的移行部。In the figure, 1 is the posterior segment, 2 is the left anterior segment, 3 is the tongue segment, 4 is the left lung oblique fissure, 5 is the left lung lobe, 6 is the tip segment, 7 is the posterior segment, and 8 is the right lung anterior segment. 9 is the right middle lobe, 10 is the right lower lobe, 11 is the left lung dorsal segment, 12 is the left lung posterior basal segment, 13 is the left extrapulmonary basal segment, 14 is the anterior basal segment, 15 is the left lung oblique fissure and The transitional part of the mediastinum of the left lung, 16 is the right lung dorsal segment, 17 is the anterior basal segment, 18 is the right extrapulmonary basal segment, 19 is the right posterior basal segment, 20 is the right lung basal segment, and 21 is the right middle lobe. 22 is the transition of the right lung oblique fissure and the right lung mediastinum.
具体实施方式detailed description
实施例1 本发明肺的段间标志点的确定方法Example 1 Method for determining inter-segment landmarks of the lung of the present invention
一、肺的段间标志点确定方法First, the method of determining the marker points between the lungs
肺表面可识别的解剖结构有肺尖、肺底、外侧的肋面、内侧的纵隔面以及前缘、后缘、下缘三个缘。The anatomical structures recognizable on the surface of the lung include the tip of the lung, the base of the lung, the rib surface on the outer side, the mediastinum on the medial side, and the leading edge, the trailing edge, and the lower edge.
左肺其余可识别的解剖结构有：斜裂后端(斜裂与后缘的交叉点)(图1A)；左上肺前下角(斜裂与前缘的交叉点)(图1A)；左肺下叶肺韧带前方斜裂面与纵隔面的移行部(图1B)；左肺下叶底缘分为两部分，即底缘内侧线(纵隔侧)及底缘外侧线(肋面侧)，前端为斜裂面与底缘的肋侧交点(图1C)，后端为斜裂面与底缘纵隔侧的交点(图1C)。The remaining anatomical structures of the left lung are: the posterior sloping cleft (the intersection of the oblique fissure and the trailing edge) (Fig. 1A); the anterior and posterior horn of the left upper lung (the intersection of the oblique fissure and the leading edge) (Fig. 1A); The anterior oblique lobes of the lower lobe and the transitional part of the mediastinum (Fig. 1B); the lower edge of the left lower lobe is divided into two parts, namely the medial line on the bottom edge (medial side) and the lateral line on the bottom edge (rib side), front end It is the rib side intersection of the oblique plane and the bottom edge (Fig. 1C), and the rear end is the intersection of the oblique plane and the mediastinum side of the bottom edge (Fig. 1C).
右肺其余可识别的解剖结构有：斜裂后端(斜裂与后缘的交叉点)(图1D)；水平裂与斜裂的交点(图1D)；右上肺前下角(水平裂与前缘的交叉点)(图1D)；右肺下叶肺韧带前方斜裂面与纵隔面的移行部(图1E)；右肺下叶分为两部分，即底缘内侧线(纵隔侧)及底缘外侧线(肋面侧)(图1F)，前端为斜裂面与底缘的肋侧交点，后端为斜裂面与底缘纵隔侧的交点(图1F)。The remaining identifiable anatomical structures of the right lung are: the dorsal end of the oblique fissure (the intersection of the oblique fissure and the trailing edge) (Fig. 1D); the intersection of the horizontal fissure and the oblique fissure (Fig. 1D); the lower right anterior superior anterior horn (horizontal fissure and anterior The intersection of the margins (Fig. 1D); the transitional section of the anterior oblique lobe and the mediastinum of the right lower lobe pulmonary ligament (Fig. 1E); the right lower lobe is divided into two parts, the medial line of the inferior border (medial side) and The outer edge of the bottom edge (rib side) (Fig. 1F), the front end is the intersection of the oblique side and the rib side of the bottom edge, and the rear end is the intersection of the oblique plane and the mediastinal side of the bottom edge (Fig. 1F).
确定方式：通过测量前缘等可识别解剖结构的长度，并通过本发明提供的计算方案确定这些段间标志点。Determining the manner: the length of the anatomical structure can be identified by measuring the leading edge or the like, and the inter-segment marking points are determined by the calculation scheme provided by the present invention.
测量前缘等可识别解剖结构的长度的具体方法：A specific method of measuring the length of the anatomical structure, such as the leading edge:
对受检者进行CT胸部肺静脉造影+高分辨薄层扫描(Simens SOMATOM Definition Flash CT)，将得到的原始二维图像通过医学数字成像和通信(Digital Imaging and Communications in Medicine,DICOM)格式储存，并导入美国EDDA Technology、医软信息科技(上海)有限公司开发的“IQQA-3D胸肺术前评估和治疗计划辅助***”(EDDA科技提供)，通过利用软件所提供的测量工具，对段间标志点与肺表面可识别的解剖结构 的位置关系进行测量。The subject was subjected to CT chest venous venography + high-resolution thin-layer scanning (Simens SOMATOM Definition Flash CT), and the obtained original two-dimensional image was stored in the Digital Imaging and Communications in Medicine (DICOM) format. Introduced the "IQQA-3D Pre-operative Assessment and Treatment Plan Aid System for Thoracic Lungs" developed by EDDA Technology and SOFTWARE (Shanghai) Co., Ltd. (provided by EDDA Technology), using the measurement tools provided by the software, the inter-segment mark The positional relationship of the point to the anatomical structure recognizable on the surface of the lung is measured.
需要测量的Need to measure
通过本发明提供的计算方案确定这些段间标志点的具体方法：A specific method for determining the marker points between the segments by the calculation scheme provided by the present invention:
1.左上肺：1. Left upper lung:
左肺上叶各肺段的段间标志点如图2所示。包括：前缘尖后段与前段的交界点；前缘前段与舌段的交界点；斜裂尖后段与舌段的交界点；尖后段、前段及舌段在肋面的交汇点。The inter-segment markers of the lung segments of the upper left lobe are shown in Figure 2. Including: the boundary point between the front and the front of the leading edge; the boundary between the front and the tongue of the leading edge; the boundary between the rear and the tongue of the oblique tip; the intersection of the rear, front and tongue of the tip at the rib.
所测量的数据为：(1)前缘的长度；(2)斜裂的长度。The measured data is: (1) the length of the leading edge; (2) the length of the oblique split.
计算方案：Calculation plan:
(1)前缘尖后段与前段的交界点位于前缘的上1/5处；(1) The junction of the trailing edge of the leading edge and the front section is located at the upper 1/5 of the leading edge;
(2)前缘前段与舌段的交界点位于前缘的上3/5处；(2) The boundary point between the front edge of the leading edge and the tongue segment is located at the upper 3/5 of the leading edge;
(3)斜裂尖后段与舌段的交界点位于斜裂的上2/5处；(3) The boundary point between the posterior segment of the oblique fissure and the tongue segment is located at the upper 2/5 of the oblique fissure;
(4)尖后段、前段及舌段在肋面的交汇点位于斜裂尖后段与舌段的交界点与前缘前段与舌段的交界点在肋面连线的后1/5处。(4) The intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection .
2.左下肺：2. Left lower lung:
左肺下叶各肺段的段间标志点如图3所示。包括：斜裂背段与前内基底段的交界点；斜裂面与纵隔面移行部背段与前内基底段的交界点(与斜裂背段与前内基底段的交界点在同一水平位置)；左下肺后缘背段与后基底段的交界点；背段、前内基底段及外基底段在肋面的交汇点；背段、外基底段及后基底段在肋面的交汇点；背段、前内基底段及后基底段在纵隔面的交汇点；底缘外侧线前内基底段与外基底段的交界点；底缘外侧线外基底段与后基底段的交界点；底缘外侧线前内基底段与后基底段的交界点；前内基底段、外基底段及后基底段在肺底的交汇点。The inter-segmental markers of the lung segments of the left lower lobe are shown in Figure 3. Including: the boundary point between the oblique fractured segment and the anterior basal segment; the junction between the oblique segment and the medial segment of the mediastinum and the anterior basal segment (at the same level as the junction between the oblique segment and the anterior basal segment) Position); the junction point between the dorsal segment of the posterior margin of the left lower lung and the posterior basal segment; the intersection of the dorsal segment, the anterior inner segment and the outer base segment at the rib surface; the intersection of the dorsal segment, the outer base segment and the posterior base segment at the rib surface Point; the intersection of the back section, the front inner base section and the rear base section at the mediastinum; the boundary point between the inner base section and the outer basement section of the outer edge of the bottom edge; the boundary point between the outer basement section and the rear basement section of the outer edge of the bottom edge The junction point between the inner base segment and the posterior base segment of the outer edge of the lateral edge; the intersection of the anterior base segment, the outer base segment and the posterior base segment at the lung base.
所测量的数据为：(1)左下肺后缘的长度；(2)底缘外侧线的长度。The measured data are: (1) the length of the trailing edge of the left lower lung; (2) the length of the lateral line of the bottom margin.
计算方案：Calculation plan:
(1)斜裂背段与前内基底段的交界点位于斜裂的上2/5处；(1) The boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
(2)后缘背段与后基底段的交界点位于左下叶后缘的中点处；(2) the boundary point between the back edge of the trailing edge and the posterior basement segment is located at the midpoint of the trailing edge of the left lower lobe;
(3)底缘外侧线前内基底段与后基底段的交界点位于底缘外侧线的内1/10处；(3) The boundary point between the inner base segment and the rear base segment of the outer edge of the bottom edge is located at 1/10 of the outer line of the bottom edge;
(4)底缘外侧线内基底段与外基底段的交界点位于底缘外侧线的外1/4处；(4) the boundary point between the base segment and the outer base segment in the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
(5)底缘外侧线外基底段与后基底段的交界点位于底缘外侧线的中点处；(5) the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
(6)背段(此处的背段是指左肺下叶背段)、前内基底段及外基底段在肋面的交汇点位于后缘背段与后基底段的交界点和斜裂背段与前内基底段的交界点在肋面连线的前3/10处；(6) The dorsal segment (here, the dorsal segment refers to the dorsal segment of the left lower lobe), the intersection of the anterior basal segment and the outer basal segment at the rib surface is located at the junction of the dorsal and posterior basal segments of the posterior margin and the oblique fissure The junction point between the back section and the front inner base section is at the first 3/10 of the line connecting the ribs;
(7)背段、外基底段及后基底段在肋面的交汇点位于后缘背段与后基底段的交界点和斜裂背段与前内基底段的交界点在肋面连线的后1/10处；(7) The intersection of the back section, the outer base section and the rear base section at the rib surface is located at the junction of the back edge of the trailing edge and the rear basement section and the junction of the oblique split back section and the front inner basement section is connected at the rib surface. After 1/10;
(8)背段、前内基底段及后基底段在纵隔面的交汇点位于后缘背段与后基底段的交界点和斜裂面与纵隔面移行部背段与前内基底段的交界点连线的前1/5处；(8) The intersection of the dorsal segment, the anterior inner base segment and the posterior basement segment at the mediastinum is located at the junction of the posterior anterior and posterior basal segments and the boundary between the oblique and longitudinal medial segment and the anterior medial segment The first 1/5 of the point connection;
(9)前内基底段、外基底段及后基底段的在肺底交汇点位于底缘外侧线前内基底段与后基底段的交界点和底缘外侧线前内基底段与外基底段的交界点连线的外3/5处。(9) The anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment. The junction point is 3/5 outside the line.
3.右上肺：3. Right upper lung:
右肺上叶各肺段的段间标志点如图4所示。包括：前缘尖段与前段的交界点；后缘尖段与后段的交界点；水平裂前段与后段的交界点；尖段、后段及前段在肋面的交汇点。The inter-segmental markers of the lung segments of the right upper lobe are shown in Figure 4. Including: the junction point of the leading edge and the front section; the junction point of the trailing edge and the rear section; the junction point of the front section and the back section of the horizontal section; the intersection point of the tip section, the back section and the front section at the rib surface.
所测量的数据为：(1)右上肺前缘的长度；(2)右上肺后缘的长度；(3)水平裂的长度。The measured data are: (1) the length of the right upper lung leading edge; (2) the length of the right upper lung posterior margin; and (3) the length of the horizontal split.
计算方案：Calculation plan:
(1)前缘尖段与前段的交界点位于右上肺前缘的中点处；(1) The junction point between the leading edge of the leading edge and the anterior segment is located at the midpoint of the leading edge of the right upper lung;
(2)水平裂前段与后段的交界点位于水平裂的前4/5处；(2) The junction between the front and rear sections of the horizontal split is located at the first 4/5 of the horizontal split;
(3)后缘后段与尖段的交界点位于上叶后缘的中点处；(3) the boundary point between the posterior edge and the tip segment is located at the midpoint of the trailing edge of the upper lobe;
(4)尖段、后段及前段在肋面的交汇点与水平裂前段与后段的交界点的连线与水平裂的夹角为90度。(4) The angle between the intersection of the tip section, the back section and the front section at the intersection of the rib surface and the junction of the front section and the back section of the horizontal section is 90 degrees.
4.右下肺：4. Right lower lung:
右肺下叶各段间标志点如图5所示。包括：斜裂背段与前基底段的交界点；斜裂面与纵隔面移行部背段与内基底段的交界点(与斜裂背段与前基底段的交界点在同一水平位置)；背段、前基底段及外基底段在肋面的交汇点；背段、外基底段及后基底段在肋面的交汇点；背段、内基底段、后基底段在纵隔面的交汇点；背段、内基底段、前段在斜裂面的交汇点；后缘背段与后基底段的交界点；底缘内侧线内基底段与前基底段的交界点；底缘外侧线前基底段与外基底段的交界点；底缘外侧线外基底段与后基底段的交界点；底缘外侧线内基底段与后基底段的交界点；内基底段、前基底段、外基底段及后基底段在肺底的交汇点。The marker points between the segments of the right lower lobe are shown in Figure 5. The method includes: a boundary point between the oblique split back section and the front basement section; a boundary point between the oblique split surface and the longitudinal section of the longitudinal partition portion and the inner basement section (at the same horizontal position as the boundary point between the oblique split back section and the front basement section); The intersection of the back section, the front base section and the outer base section at the rib surface; the intersection of the back section, the outer base section and the rear base section at the rib surface; the intersection of the back section, the inner base section and the rear base section at the mediastinum The intersection of the back section, the inner base section and the front section at the oblique plane; the junction of the trailing edge back section and the rear basement section; the boundary point between the basement section and the front basement section in the inner edge of the bottom edge; a junction point between the segment and the outer base segment; a boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge; a boundary point between the base segment and the rear base segment at the outer edge of the bottom edge; the inner base segment, the front base segment, and the outer base segment And the junction of the posterior basal segment at the base of the lung.
所测量的数据为：(1)斜裂的长度；(2)右下肺后缘的长度；(3)底缘内侧线的长度；(4)底缘外侧线的长度。The measured data are: (1) the length of the oblique fissure; (2) the length of the posterior edge of the right lower lung; (3) the length of the inner line of the bottom edge; and (4) the length of the outer line of the bottom edge.
计算方案：Calculation plan:
(1)斜裂背段与前基底段的交界点位于斜裂的上2/5处；(1) The boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
(2)后缘背段与后基底段的交界点位于右下叶后缘(此处的下叶后缘是指右下肺后缘)的上2/5处；(2) The junction between the posterior anterior and posterior basal segments is located at the upper 2/5 of the posterior border of the right lower lobe (where the posterior border of the lower lobe refers to the posterior border of the right lower lung);
(3)底缘内侧线前基底段与内基底段的交界点位于底缘内侧线的中点处；(3) the boundary point between the front base segment and the inner base segment of the inner edge of the bottom edge is located at the midpoint of the inner line of the bottom edge;
(4)底缘外侧线内基底段与后基底段的交界点位于底缘外侧线的内1/10处；(4) the boundary point between the base segment and the rear basement segment in the outer edge of the bottom edge is located at 1/10 of the outer line of the bottom edge;
(5)底缘外侧线前基底段与外基底段的交界点位于底缘外侧线的外1/4处；(5) The boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
(6)底缘外侧线外基底段与后基底段的交界点位于底缘外侧线的中点处；(6) the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
(7)背段、前基底段及外基底段在肋面的交汇点位于后缘背段与后基底段的交界点与斜裂背段与前基底段的交界点在肋面连线的约前3/10处；(7) The intersection of the back section, the front base section and the outer base section at the rib surface is located at the junction of the trailing edge back section and the rear basement section and the junction of the oblique split back section and the front basement section at the rib surface connection The first 3/10 places;
(8)背段、外基底段及后基底段在肋面的交汇点与后缘背段与后基底段的交界点重合。(8) The intersection of the back section, the outer base section and the rear base section at the rib surface coincides with the junction of the trailing edge back section and the rear base section.
(9)背段、前基底段及内基底段在斜裂面的交汇点位于斜裂背段与前基底段的交界点和斜裂面与纵隔面移行部背段与内基底段的交界点(即在斜裂面与纵隔面移行部，与点位(1)(即斜裂背段与前基底段的交界点)的位置平行的一点)的连线的约前中点处；(9) The intersection of the dorsal segment, the anterior basal segment and the inner basal segment at the oblique plane is located at the junction of the oblique cleft segment and the anterior basal segment and the boundary between the oblique segment and the medial segment of the mediastinum (ie, at the midpoint of the line connecting the oblique plane and the mediastinum, at a point parallel to the position of the point (1) (ie, the point of intersection of the oblique fracture back and the anterior basement);
(10)背段、内基底段及后基底段在纵隔面的交汇点位于后缘背段与后基底段的交界点和斜裂面与纵隔面移行部背段与内基底段的交界点连线的约前1/5处；(10) The intersection of the back section, the inner base section and the rear basement section at the mediastinum is located at the junction of the posterior anterior and posterior basal segments and the junction of the oblique and the mediastinum and the medial segment of the mediastinum About 1/5 of the line;
(11)内基底段、前基底段、外基底段及后基底段在肺底的交汇点与底缘外侧线前基底段与外基底段的交界点的连线与底缘外侧线的夹角为90度。(11) The angle between the line connecting the inner base segment, the anterior base segment, the outer base segment and the posterior base segment at the junction of the lung base and the boundary between the anterior base segment and the outer base segment of the outer edge of the bottom edge and the outer edge of the bottom edge It is 90 degrees.
(12)内基底段、前基底段、外基底段及后基底段在肺底的交汇点与底缘内侧线内基底段与前基底段的交界点的连线与底缘内侧线的夹角为90度。(12) The angle between the line connecting the inner base segment, the anterior base segment, the outer base segment and the posterior base segment at the junction of the lung base and the boundary between the base segment and the anterior base segment at the inner edge of the bottom edge and the inner line of the bottom edge It is 90 degrees.
二、验证Second, verification
1、将上述方法确定各肺段的段间标志点间的长度与肺表面解剖结构长度的比例按性别、年龄、体重和身高分组，组间均无统计学差异，说明本发明确定的比例长度在不同个体间的一致性很好，能够反应段间标志点的真实位置，可广泛用于不同患者。1. The above method was used to determine the ratio of the length between the inter-segment marking points of each lung segment to the length of the anatomical structure of the lung surface according to gender, age, body weight and height. There was no statistical difference between the groups, indicating the proportional length determined by the present invention. The consistency among different individuals is very good, and it can reflect the true position of the marker points between the segments, and can be widely used in different patients.
2、在做三微重建时加入了肺静脉的重建，而已知段间静脉走形于肺段之间，所以根据段间静脉的走形可以确认肺段范围大小的准确性，从而间接验证肺段标志点的准确性。2. The reconstruction of the pulmonary vein was added during the three-micro reconstruction. It is known that the inter-segmental veins are shaped between the lung segments. Therefore, according to the shape of the inter-segmental vein, the accuracy of the size of the lung segment can be confirmed, thereby indirectly verifying the lung segment. The accuracy of the marker points.
实施例2 本发明肺段模型的制备方法Example 2 Preparation method of lung segment model of the present invention
根据实施例1中测定的每个病人的肺可识别的解剖结构的数据，制备肺模型，然后根据实施例1方法确定的段间标志点的位置，在肺模型上安装每个段间标志点，以便于解剖性肺段切除术使用，本发明方法制备得到的肺段模型如下：A lung model was prepared according to the data of the lung recognizable anatomy of each patient measured in Example 1, and then the inter-segment marker points were installed on the lung model according to the position of the inter-segment marker points determined by the method of Example 1. In order to facilitate the use of anatomical segmentectomy, the lung segment model prepared by the method of the present invention is as follows:
如图6所示，包括：左肺段，右肺段；所述左肺段包括：左肺上叶，左肺下叶，左肺肋面，左肺纵隔面；所述左肺上叶和左肺下叶的交界为左肺斜裂；所述左肺上叶包括：尖后段，左肺前段，舌段；所述左肺下叶包括：左肺背段，前内基底段，左肺外基底段，左肺后基底段；所述右肺段包括：右肺上叶，右肺中叶，右肺下叶，右肺肋面，右肺纵隔面；所述右肺上叶与右肺中叶的交界为右肺水平裂；所述右肺中叶与右肺下叶的交界为右肺斜裂；所述右肺上叶包括：尖段，后段，右肺前段；所述右肺下叶包括：右肺背段，前基底段，右肺外基底段，右肺后基底段，右肺内基底段；所述左肺段和右肺段中的各个肺段的形状与人体真实的肺段形状相同；所述左肺段和右肺段中的各个肺段之间均按照其在人体中的位置可拆卸连接。As shown in FIG. 6, comprising: a left lung segment, a right lung segment; the left lung segment includes: a left lung upper lobe, a left lung lobe, a left lung rib surface, a left lung mediastinum; the left lung lobe and The junction of the left lower lobe is a left lung oblique fissure; the left lobe upper lobe includes: a posterior segment of the left lung, a anterior segment of the left lung, and a segment of the tongue; the lower lobe of the left lung includes: a segment of the left lung, a anterior basal segment, and a left Extrapulmonary basal segment, left posterior basal segment; said right segment includes: right upper lobe, right middle lobe, right lower lobe, right lung rib, right lung mediastinum; right lung upper lobe and right The junction of the middle lobe of the lung is a horizontal split of the right lung; the junction of the right middle lobe and the right lower lobe is a right lung oblique fissure; the right upper lobe includes: a sharp segment, a posterior segment, a right lung anterior segment; the right lung The lower lobe includes: the right lung dorsal segment, the anterior basal segment, the right extrapulmonary basal segment, the right posterior basal segment, the right pulmonary basal segment; the shape of the lung segments in the left and right lung segments and the human body The lung segments are identical in shape; each of the left and right lung segments is detachably connected in accordance with its position in the human body.
进一步地，还包括：段间标志点；Further, the method further includes: an inter-segment mark point;
所述段间标志点包括：The inter-segment marking points include:
所述尖后段与左肺前段在左肺前缘的交界点；所述左肺前段与舌段在左肺前缘的交界点；所述尖后段、左肺前段、舌段在所述左肺肋面的交汇点；所述尖后段与舌段在所述左肺斜裂的交界点；a junction between the posterior segment of the tip and the anterior segment of the left lung at the anterior border of the left lung; the junction of the anterior segment of the left lung and the lingual segment at the anterior border of the left lung; the posterior segment of the tip, the anterior segment of the left lung, and the segment of the tongue are a junction point of the left lung rib surface; the tip posterior segment and the tongue segment at the junction of the left lung oblique fissure;
所述左肺背段与前内基底段在所述左肺斜裂的交界点；所述左肺背段、前内基底段、左肺外基底段在所述左肺肋面的交汇点；所述左肺背段、左肺外基底段、左肺后基底段在所述左肺肋面的交汇点；所述左肺背段与前内基底段在所述左肺斜裂与左肺纵隔面移行部的交界点；所述左肺背段、前内基底段、左肺后基底段在所述左肺纵隔面的交汇点；所述 左肺背段与左肺后基底段在左肺后缘的交界点；所述前内基底段与左肺外基底段在左肺底缘外侧线的交界点；所述前内基底段、左肺外基底段、左肺后基底段在左肺肺底的交汇点；所述前内基底段与左肺外基底段在左肺底缘外侧线的交界点；所述左肺外基底段与左肺后基底段在左肺底缘外侧线的交界点(如图7至图10所示)；The intersection of the left lung dorsal segment and the anterior basal segment at the left lung oblique fissure; the left lung dorsal segment, the anterior basal segment, and the left extrapulmonary basal segment at the intersection of the left pulmonary rib surface; The intersection of the left lung dorsal segment, the left extrapulmonary basal segment, and the left posterior basal segment at the left lung rib surface; the left lung dorsal segment and the anterior basal segment in the left lung oblique fissure and the left lung a junction point of the mediastinum transition portion; a intersection of the left lung dorsal segment, the anterior basal segment, and the left posterior basal segment at the left lung mediastinum; the left lung dorsal segment and the left posterior basal segment at the left a junction point of the posterior border of the lung; a junction of the anterior basal segment and the left extrapulmonary basal segment at the lateral line of the left lung rim; the anterior basal segment, the left extrapulmonary basal segment, and the left posterior basal segment at the left a junction of the lung and lung base; a boundary point between the anterior basal segment and the left extrapulmonary basal segment at the lateral line of the left lung rim; the left extrapulmonary basal segment and the left posterior basal segment at the lateral line of the left lung rim Junction point (as shown in Figures 7 to 10);
所述尖段与后段在右肺后缘的交界点；所述尖段、后段、右肺前段在所述右肺肋面的交汇点；所述尖段与右肺前段在右肺前缘的交界点；所述右肺前段与后段在所述右肺水平裂的交界点(如图6所示)；a junction between the tip segment and the posterior segment at the posterior border of the right lung; the junction of the tip segment, the posterior segment, and the right segment of the right lung at the junction of the right lung rib; the tip segment and the anterior segment of the right lung in front of the right lung a junction point of the edge; the junction of the anterior and posterior segments of the right lung at the horizontal split of the right lung (as shown in Figure 6);
所述右肺背段与前基底段在所述右肺斜裂的交界点；所述右肺背段、前基底段、右肺外基底段在所述右肺肋面的交汇点；所述右肺背段、右肺外基底段、右肺后基底段在所述右肺肋面的交汇点；所述右肺背段与右肺内基底段在所述右肺斜裂与右肺纵隔面移行部的交界点；所述右肺背段、右肺内基底段、右肺后基底段在所述右肺肋面的交汇点；所述右肺背段与右肺后基底段在右肺后缘的交界点；所述右肺背段、前基底段、右肺内基底段在所述右肺斜裂的交汇点；所述前基底段与右肺内基底段在右肺底缘内侧线的交界点；所述前基底段与右肺外基底段在右肺底缘外侧线的交界点；所述右肺内基底段、前基底段、右肺外基底段、右肺后基底段在右肺肺底的交汇点；所述右肺内基底段与右肺后基底段在右肺底缘外侧线的交界点；所述右肺外基底段与右肺后基底段在右肺底缘外侧线的交界点(如图11至图12所示)。a junction of the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure; the right lung dorsal segment, the anterior basal segment, and the right extrapulmonary basal segment at a junction of the right pulmonary rib surface; a junction of the right lung dorsal segment, the right extrapulmonary basal segment, and the right posterior pulmonary basal segment at the right lung rib surface; the right lung dorsal segment and the right pulmonary basal segment in the right lung oblique fissure and the right lung mediastinum a junction point of the facial transition portion; a junction of the right lung dorsal segment, the right pulmonary basal segment, and the right posterior pulmonary basal segment at the right lung rib surface; the right lung dorsal segment and the right lung posterior basal segment at the right a junction point of the posterior lung; the right anterior segment, the anterior basal segment, and the right lung basal segment at the junction of the right lung oblique fissure; the anterior basal segment and the right pulmonary basal segment at the right lung margin a junction point of the medial line; a junction of the anterior basal segment and the right extrapulmonary basal segment at the lateral line of the right lung base; the right basal segment of the right lung, the anterior basal segment, the right extrapulmonary basal segment, and the right posterior pulmonary basal The junction of the segment of the right lung and the base of the lung; the boundary between the right lung basal segment and the right posterior basal segment at the lateral line of the right lung base; the right extrapulmonary basal segment and the right lung In the bottom section the junction of the outer edge of the right base line (as shown in FIG. 11 to FIG. 12).
其中，所述尖后段与左肺前段在左肺前缘的交界点位于所述左肺前缘的上1/5处；所述左肺前段与舌段在左肺前缘的交界点位于所述左肺前缘的上3/5处；所述尖后段与舌段在所述左肺斜裂的交界点为第一交界点，所述左肺前段与舌段在左肺前缘的交界点为第二交界点，所述尖后段、左肺前段、舌段在所述左肺肋面的交汇点位于所述第一交界点与所述第二交界点连线的后1/5处；所述尖后段与舌段在所述左肺斜裂的交界点位于所述左肺 斜裂的上2/5处；Wherein, the junction of the posterior anterior segment and the left anterior segment at the left lung anterior border is located at the upper 1/5 of the left lung anterior border; the left lung anterior segment and the tongue segment are located at the junction of the left pulmonary anterior border The upper 3/5 of the left lung leading edge; the tip posterior segment and the tongue segment at the junction of the left lung oblique fissure are the first junction point, and the left lung anterior segment and the tongue segment are at the left lung leading edge The junction point is a second junction point, and the intersection point of the tip posterior segment, the left lung anterior segment, and the tongue segment at the left lung rib surface is located at the intersection of the first junction point and the second junction point. /5; the tip posterior segment and the tongue segment are located at the upper 2/5 of the left lung oblique fissure at the junction of the left lung oblique fissure;
所述左肺背段与前内基底段在所述左肺斜裂的交界点位于所述左肺斜裂的上2/5处；所述左肺背段与左肺后基底段在左肺后缘的交界点位于左肺后缘的中点处；所述前内基底段与左肺后基底段在左肺底缘外侧线的交界点位于所述左肺底缘外侧线的内1/10处；所述前内基底段与左肺外基底段在左肺底缘外侧线的交界点位于所述左肺底缘外侧线的外1/4处；所述左肺外基底段与左肺后基底段在左肺底缘外侧线的交界点位于所述左肺底缘外侧线的中点处；所述左肺背段与左肺后基底段在左肺后缘的交界点为第三交界点，所述左肺背段与前内基底段在所述左肺斜裂的交界点为第四交界点，所述左肺背段、前内基底段、左肺外基底段在所述左肺肋面的交汇点位于所述第三交界点和所述第四交界点在所述左肺肋面连线的前3/10处；所述左肺背段、左肺外基底段、左肺后基底段在所述左肺肋面的交汇点位于所述第三交界点和所述第四交界点在所述左肺肋面连线的后1/10处；所述左肺背段与前内基底段在所述左肺斜裂与左肺纵隔面移行部的交界点为第五交界点，所述左肺背段、前内基底段、左肺后基底段在所述左肺纵隔面的交汇点位于所述第三交界点和所述第五交界点连线的前1/5处；所述前内基底段与左肺后基底段在左肺底缘外侧线的交界点为第六交界点，所述前内基底段与左肺外基底段在左肺底缘外侧线的交界点为第七交界点，所述前内基底段、左肺外基底段、左肺后基底段在左肺肺底的交汇点位于所述第六交界点和所述第七交界点连线的外3/5处；The left lung dorsal segment and the anterior basal segment at the junction of the left lung oblique fissure are located at the upper 2/5 of the left lung oblique fissure; the left lung dorsal segment and the left posterior basal segment in the left lung The junction of the posterior margin is located at the midpoint of the posterior edge of the left lung; the junction of the anterior basal segment and the posterior ligament of the left lung at the lateral line of the left lung rim is located within the lateral line of the left lung margin 10; the junction between the anterior basal segment and the left extrapulmonary basal segment at the lateral line of the left lung rim is located at the outer 1/4 of the lateral line of the left lung rim; the left extrapulmonary basal segment and the left The junction point of the posterior lung basal segment at the lateral line of the left lung bottom edge is located at the midpoint of the lateral line of the left lung bottom edge; the junction between the left lung dorsal segment and the left posterior basal segment at the posterior border of the left lung is At the three junction points, the boundary between the left lung dorsal segment and the anterior basal segment at the junction of the left lung oblique fissure is a fourth junction point, and the left lung dorsal segment, the anterior basal segment, and the left extrapulmonary basal segment are The intersection of the left pulmonary rib surface is located at the third interface point and the fourth boundary point at the first 3/10 of the line connecting the left lung rib surface; the left lung dorsal segment and the left extrapulmonary basal segment Left lung a junction of the base segment at the left lung rib surface at the third junction point and the fourth junction point at the rear 1/10 of the line connecting the left lung rib surface; the left lung segment and the front The inner basal segment is a fifth junction point at the junction of the left lung oblique fissure and the left lung mediastinum transition portion, and the left lung dorsal segment, the anterior basal segment, and the left posterior basal segment are at the left lung mediastinum The junction point is located at the first 1/5 of the line connecting the third junction point and the fifth junction point; the junction of the anterior basal segment and the left posterior basal segment at the lateral line of the left lung rim is At the six junction points, the junction between the anterior basal segment and the left extrapulmonary basal segment at the lateral line of the left lung rim is the seventh junction point, the anterior basal segment, the left extrapulmonary basal segment, and the left posterior basal segment a junction at the bottom of the left lung is located at the outer 3/5 of the line connecting the sixth junction point and the seventh junction point;
所述尖段与右肺前段在右肺前缘的交界点位于左肺前缘的中点处；所述右肺前段与后段在所述右肺水平裂的交界点位于所述右肺水平裂的前4/5处；所述后段与右肺前段在右肺后缘的交界点位于右肺后缘的中点处；所述尖段、后段、右肺前段在所述右肺肋面的交汇点和所述右肺前段与后段在所述右肺水平裂的交界点的连线，与所述右肺水平裂的夹角为90度；The junction between the tip segment and the right lung anterior segment at the right lung anterior border is located at a midpoint of the left lung anterior border; the right lung anterior segment and the posterior segment at the junction of the right lung horizontal fissure are located at the right lung level The first 4/5 of the split; the posterior segment of the right lung and the anterior segment of the right lung at the posterior border of the right lung are located at the midpoint of the posterior margin of the right lung; the tip, the posterior, and the right lung are in the right lung The intersection of the rib surface and the junction of the right lung anterior segment and the posterior segment at the junction of the right lung horizontal fissure, and the angle of the right lung horizontal fissure is 90 degrees;
所述右肺背段与前基底段在所述右肺斜裂的交界点位于所述右肺斜裂的上2/5处；所述右肺背段与右肺后基底段在右肺后缘的交界点位于所述右肺后缘的上2/5处；所述前基底段与右肺内基底段在右肺底缘内测线的交界点位于所述右肺底缘内测线的中点处；所述右肺内基底段与右肺后基底段在右肺底缘外侧线的交界点位于所述右肺底缘外侧线的内1/10处；所述前基底段与右肺外基底段在所述右肺底缘外侧线的交界点位于所述右肺底缘外侧线的1/4处；所述右肺外基底段与右肺后基底段在所述右肺底缘外侧线的交界点位于所述右肺底缘外侧线的中点处；所述右肺背段与右肺后基底段在右肺后缘的交界点为第八交界点，所述右肺背段与前基底段在所述右肺斜裂的交界点为第九交界点，所述右肺背段、前基底段、右肺外基底段在所述右肺肋面的交汇点位于所述第八交界点和所述第九交界点在所述右肺肋面连线的前3/10处；所述右肺背段、右肺外基底段、右肺后基底段在所述右肺肋面的交汇点与所述第八交界点重合；所述右肺背段与右肺内基底段在所述右肺斜裂与右肺纵隔面移行部的交界点为第十交界点，所述右肺背段、前基底段、右肺内基底段在所述右肺斜裂的交汇点位于所述第九交界点和所述第十交界点的连线的中点处；所述右肺背段、右肺内基底段、右肺后基底段在所述右肺纵隔面的交汇点位于所述第八交界点和所述第十交界点连线的前1/5处；所述右肺内基底段、前基底段、右肺外基底段、右肺后基底段在右肺肺底的交汇点和所述前基底段与右肺外基底段在右肺底缘外侧线的交界点的连线，与所述右肺底缘外侧线的夹角为90度；所述右肺内基底段、前基底段、右肺外基底段、右肺后基底段在右肺肺底的交汇点和所述右肺内基底段与前基底段在右肺底缘内侧线的交界点的连线，与所述右肺底缘内侧线的夹角为90度。The boundary between the right lung dorsal segment and the anterior basal segment at the right lung oblique fissure is located at the upper 2/5 of the right lung oblique fissure; the right lung dorsal segment and the right posterior pulmonary basal segment are behind the right lung The junction of the rim is located at the upper 2/5 of the posterior edge of the right lung; the junction of the anterior basal segment and the basal segment of the right lung at the bottom line of the right lung is located at the bottom line of the right lung The midpoint of the right lung and the posterior lung basal segment at the lateral line of the right lung bottom edge are located at 1/10 of the outer line of the right lung bottom edge; the anterior basement segment a junction point of the right extrapulmonary basal segment at the lateral line of the right lung bottom edge is located at 1/4 of the lateral line of the right lung bottom edge; the right extrapulmonary basal segment and the right posterior basal segment are in the right lung a junction point of the lateral line of the bottom edge is located at a midpoint of the outer line of the right lung bottom edge; the boundary point between the right lung back segment and the right lung posterior basal segment at the posterior border of the right lung is the eighth junction point, the right The junction between the dorsal lung segment and the anterior basal segment at the junction of the right lung oblique fissure is a ninth junction point, and the right lung dorsal segment, the anterior basal segment, and the right extrapulmonary basal segment are located at the intersection of the right lung rib surfaces The first The eight junction point and the ninth junction point are in the first 3/10 of the line connecting the right lung rib surface; the right lung back section, the right extrapulmonary basal section, and the right lung posterior basal section are in the right lung rib a junction of the face coincides with the eighth junction point; the boundary point between the right lung dorsal segment and the right pulmonary basal segment at the right lung oblique fissure and the right lung mediastinum transition portion is a tenth junction point, a right lung dorsal segment, a anterior basal segment, and a right pulmonary basal segment at a junction of the right lung oblique fissure at a midpoint of a line connecting the ninth junction point and the tenth junction point; the right lung a junction of the dorsal segment, the right intrapulmonary basal segment, and the right posterior pulmonary basal segment at the right lung mediastinum is located at the first 1/5 of the line connecting the eighth junction point and the tenth junction point; The junction of the basal segment of the lung, the anterior basal segment, the right extrapulmonary basal segment, and the right posterior basal segment at the junction of the right lung and the basement of the lung and the junction of the anterior basal segment and the right extrapulmonary basal segment at the lateral line of the right lung The line connecting the outer line of the right lung bottom edge is 90 degrees; the right lung inner basal segment, the anterior basal segment, the right extrapulmonary basal segment, and the right posterior basal segment at the right lung base Intersection and the segment of the right lung and the front substrate at the substrate section connecting the junction point of the inner edge of the right base line, the angle between the inner edge of the right base line is 90 degrees.
本发明方法制备的肺段模型，通过模拟真实的人体左右肺段、在该肺段模型上安装段间标志点，并精确地定义了各个段间标志点的位置，使抽象的段间平面可量化，使得外科手术医生在术前对于肺段的解剖结构一目了然，从而能够指导手术医生进行精准的肺段切 除。此外，本模型的各个肺段之间可拆卸连接，使得各个肺段之间的解剖关系更加清楚，进一步满足医生教学、研究的需求。The lung segment model prepared by the method of the invention simulates the real left and right lung segments of the human body, installs inter-segment landmarks on the lung segment model, and precisely defines the position of the marker points between the segments, so that the abstract inter-segment plane can be Quantification allows the surgeon to see the anatomy of the lung segment at a glance before surgery, thus guiding the surgeon to perform accurate segmentectomy. In addition, the detachable connection between the various lung segments of the model makes the anatomical relationship between the various lung segments clearer, further satisfying the needs of doctors' teaching and research.

Claims (5)

  1. 肺的段间标志点的确定方法，其特征在于：步骤如下：A method for determining a marker point between segments of a lung is characterized in that the steps are as follows:
    (1)对待检的肺进行CT胸部肺静脉造影加高分辨薄层扫描；对原始图像进行三维重建，根据支气管、叶支气管、段支气管、亚段支气管及终末细支气管的走形生成支气管树的三维模型，并以此为依据构建三维肺段影像；同时通过段间静脉的路径，对基于支气管树三维重建生成的肺段影像模型的边界范围进行准确界定；(1) CT lung chest venography and high-resolution thin-layer scanning were performed on the lungs to be examined; three-dimensional reconstruction of the original image was performed, and bronchial trees were generated according to the shape of the bronchi, leaf bronchus, segmental bronchi, sub-bronchus and terminal bronchioles. The three-dimensional model is used to construct a three-dimensional lung segment image; and the boundary range of the lung segment image model generated based on the three-dimensional reconstruction of the bronchial tree is accurately defined by the path of the intervenous vein;
    (2)确定肺表面可识别的解剖结构点及边界线，并以这些结构及他们之间的交叉点或交线作为参照，对肺表面各肺段的段间位置与上述可识别的肺部解剖结构标志的相对位置关系进行测量，并大数据计算其所在解剖标志线上的长度比例，来确定段间标志点的位置。(2) Determining the anatomical points and boundary lines recognizable on the surface of the lung, and using these structures and their intersections or intersections as a reference, the inter-segment position of each lung segment on the lung surface and the above-identifiable lungs The relative positional relationship of the anatomical landmarks is measured, and the ratio of the length of the anatomical landmark line on the anatomical landmark is calculated to determine the position of the marker points between the segments.
  2. 肺的段间标志点的确定方法，其特征在于：步骤如下：A method for determining a marker point between segments of a lung is characterized in that the steps are as follows:
    (1)对待检的肺进行CT胸部肺静脉造影和高分辨薄层扫描，测量肺表面可识别的解剖结构点、边界线及其连线之间的数据；(1) CT chest pulmonary vein angiography and high-resolution thin-layer scanning are performed on the lungs to be examined, and data between anatomical points, boundary lines and their connections on the surface of the lungs are measured;
    (2)根据肺表面可识别的解剖结构的数据，确定段间标志点的位置。(2) Determine the position of the marker points between the segments based on the data of the anatomical structures recognizable on the surface of the lungs.
  3. 根据权利要求1或2所述的确定方法，其特征在于：步骤(1)中，所述肺表面可识别的解剖结构的数据如下：The determining method according to claim 1 or 2, wherein in the step (1), the data of the anatomical structure recognizable on the surface of the lung is as follows:
    (一)左上肺：(1) Upper left lung:
    (1)左上肺前缘的长度；(2)左上肺后缘的长度；(3)斜裂的长度；(1) the length of the left superior lung leading edge; (2) the length of the left upper lung posterior margin; (3) the length of the oblique fissure;
    (二)左下肺：(2) Left lower lung:
    (1)左下肺后缘的长度；(2)底缘外侧线的长度；(3)底缘内侧线的长度(1) the length of the posterior edge of the left lower lung; (2) the length of the outer line of the bottom edge; (3) the length of the inner line of the bottom edge
    (三)右上肺：(3) Right upper lung:
    (1)右上肺前缘的长度；(2)右上肺后缘的长度；(3)水平裂的长度；(1) the length of the anterior border of the right upper lung; (2) the length of the posterior border of the right upper lung; (3) the length of the horizontal split;
    (四)右下肺：(4) Right lower lung:
    (1)斜裂的长度；(2)右下肺后缘的长度；(3)底缘内侧线的长度；(4)底缘外侧线的长度。(1) the length of the oblique fissure; (2) the length of the posterior edge of the right lower lung; (3) the length of the inner line of the bottom edge; and (4) the length of the outer line of the bottom edge.
  4. 根据权利要求1或2所述的确定方法，其特征在于：步骤(2)中，确定段间标志点的位置的方式如下：The determining method according to claim 1 or 2, wherein in the step (2), the manner of determining the position of the inter-segment marker points is as follows:
    (一)左上肺：(1) Upper left lung:
    (1)前缘尖后段与前段的交界点位于前缘的上1/5处；(1) The junction of the trailing edge of the leading edge and the front section is located at the upper 1/5 of the leading edge;
    (2)前缘前段与舌段的交界点位于前缘的上3/5处；(2) The boundary point between the front edge of the leading edge and the tongue segment is located at the upper 3/5 of the leading edge;
    (3)斜裂尖后段与舌段的交界点位于斜裂的上2/5处；(3) The boundary point between the posterior segment of the oblique fissure and the tongue segment is located at the upper 2/5 of the oblique fissure;
    (4)尖后段、前段及舌段在肋面的交汇点位于斜裂尖后段与舌段的交界点与前缘前段与舌段的交界点在肋面连线的后1/5处；(4) The intersection of the posterior segment, the anterior segment and the tongue segment at the rib surface is located at the junction of the posterior segment of the oblique tip and the tongue segment and the junction between the anterior segment of the leading edge and the tongue segment at the 1/5th line of the rib surface connection ;
    (二)左下肺：(2) Left lower lung:
    (1)斜裂背段与前内基底段的交界点位于斜裂的上2/5处；(1) The boundary point between the oblique split back section and the front inner basement section is located at the upper 2/5 of the oblique split;
    (2)后缘背段与后基底段的交界点位于下叶后缘的中点处；(2) the boundary point between the back edge of the trailing edge and the rear basement segment is located at the midpoint of the trailing edge of the lower blade;
    (3)底缘外侧线前内基底段与后基底段的交界点位于底缘外侧线的内1/10处；(3) The boundary point between the inner base segment and the rear base segment of the outer edge of the bottom edge is located at 1/10 of the outer line of the bottom edge;
    (4)底缘外侧线内基底段与外基底段的交界点位于底缘外侧线的外1/4处；(4) the boundary point between the base segment and the outer base segment in the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
    (5)底缘外侧线外基底段与后基底段的交界点位于底缘外侧线的中点处；(5) the boundary point between the outer basement segment and the rear basement segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
    (6)背段、前内基底段及外基底段在肋面的交汇点位于后缘背段与后基底段的交界点和斜裂背段与前内基底段的交界点在肋面连线的前3/10处；(6) The intersection of the back section, the front inner base section and the outer base section at the rib surface is located at the junction of the trailing edge back section and the rear base section and the junction of the oblique split back section and the front inner base section on the rib surface The first 3/10 places;
    (7)背段、外基底段及后基底段在肋面的交汇点位于后缘背段与后基底段的交界点和斜裂背段与前内基底段的交界点在肋面连线的后1/10处；(7) The intersection of the back section, the outer base section and the rear base section at the rib surface is located at the junction of the back edge of the trailing edge and the rear basement section and the junction of the oblique split back section and the front inner basement section is connected at the rib surface. After 1/10;
    (8)背段、前内基底段及后基底段在纵隔面的交汇点位于后缘背段与后基底段的交 界点和斜裂面与纵隔面移行部背段与前内基底段的交界点连线的前1/5处；(8) The intersection of the dorsal segment, the anterior inner base segment and the posterior basement segment at the mediastinum is located at the junction of the posterior anterior and posterior basal segments and the boundary between the oblique and longitudinal medial segment and the anterior medial segment The first 1/5 of the point connection;
    (9)前内基底段、外基底段及后基底段的在肺底交汇点位于底缘外侧线前内基底段与后基底段的交界点和底缘外侧线前内基底段与外基底段的交界点连线的外3/5处；(9) The anterior basement segment, the outer basal segment and the posterior basal segment are located at the junction of the basal segment and the posterior basal segment at the junction of the anterior base of the basal rim and the basal segment of the anterior basal segment and the basal segment. 3/5 outside the junction of the junction;
    (三)右上肺：(3) Right upper lung:
    (1)前缘尖段与前段的交界点位于上叶前缘的中点处；(1) the junction point between the leading edge of the leading edge and the front segment is located at the midpoint of the leading edge of the upper lobe;
    (2)水平裂前段与后段的交界点位于水平裂的前4/5处；(2) The junction between the front and rear sections of the horizontal split is located at the first 4/5 of the horizontal split;
    (3)后缘后段与尖段的交界点约于上叶后缘的中点处；(3) the boundary point between the posterior edge and the tip segment is about the midpoint of the posterior edge of the upper lobe;
    (4)尖段、后段及前段在肋面的交汇点与水平裂前段与后段的交界点的连线与水平裂的夹角为90度；(4) The angle between the intersection of the tip section, the back section and the front section at the intersection of the rib surface and the junction of the front section and the back section of the horizontal section is 90 degrees with the horizontal crack;
    (四)右下肺：(4) Right lower lung:
    (1)斜裂背段与前基底段的交界点位于斜裂的上2/5处；(1) The boundary point between the oblique split back section and the front basement section is located at the upper 2/5 of the oblique split;
    (2)后缘背段与后基底段的交界点位于下叶后缘的上2/5处；(2) the boundary point between the back edge of the trailing edge and the rear basement segment is located at the upper 2/5 of the trailing edge of the lower blade;
    (3)底缘内侧线前基底段与内基底段的交界点位于底缘内侧线的中点处；(3) the boundary point between the front base segment and the inner base segment of the inner edge of the bottom edge is located at the midpoint of the inner line of the bottom edge;
    (4)底缘外侧线内基底段与后基底段的交界点位于底缘外侧线的内1/10处；(4) the boundary point between the base segment and the rear basement segment in the outer edge of the bottom edge is located at 1/10 of the outer line of the bottom edge;
    (5)底缘外侧线前基底段与外基底段的交界点位于底缘外侧线的外1/4处；(5) The boundary point between the front base segment and the outer base segment of the outer edge of the bottom edge is located at the outer quarter of the outer edge of the bottom edge;
    (6)底缘外侧线外基底段与后基底段的交界点位于底缘外侧线的中点处；(6) the boundary point between the outer base segment and the rear base segment at the outer edge of the bottom edge is located at the midpoint of the outer line of the bottom edge;
    (7)背段、前基底段及外基底段在肋面的交汇点位于后缘背段与后基底段的交界点与斜裂背段与前基底段的交界点在肋面连线的约前3/10处；(7) The intersection of the back section, the front base section and the outer base section at the rib surface is located at the junction of the trailing edge back section and the rear basement section and the junction of the oblique split back section and the front basement section at the rib surface connection The first 3/10 places;
    (8)背段、外基底段及后基底段在肋面的交汇点与后缘背段与后基底段的交界点重合；(8) the intersection of the back section, the outer base section and the rear base section at the rib surface coincides with the junction of the trailing edge back section and the rear base section;
    (9)背段、前基底段及内基底段在斜裂面的交汇点位于斜裂背段与前基底段的交界点和斜裂面与纵隔面移行部背段与内基底段的交界点的连线的约前中点处；(9) The intersection of the dorsal segment, the anterior basal segment and the inner basal segment at the oblique plane is located at the junction of the oblique cleft segment and the anterior basal segment and the boundary between the oblique segment and the medial segment of the mediastinum At the midpoint of the connection;
    (10)背段、内基底段及后基底段在纵隔面的交汇点位于后缘背段与后基底段的交界点和斜裂面与纵隔面移行部背段与内基底段的交界点连线的约前1/5处；(10) The intersection of the back section, the inner base section and the rear basement section at the mediastinum is located at the junction of the posterior anterior and posterior basal segments and the junction of the oblique and the mediastinum and the medial segment of the mediastinum About 1/5 of the line;
    (11)内基底段、前基底段、外基底段及后基底段在肺底的交汇点与底缘外侧线前基底段与外基底段的交界点的连线与底缘外侧线的夹角为90度；(11) The angle between the line connecting the inner base segment, the anterior base segment, the outer base segment and the posterior base segment at the junction of the lung base and the boundary between the anterior base segment and the outer base segment of the outer edge of the bottom edge and the outer edge of the bottom edge At 90 degrees;
    (12)内基底段、前基底段、外基底段及后基底段在肺底的交汇点与底缘内侧线内基底段与前基底段的交界点的连线与底缘内侧线的夹角为90度。(12) The angle between the line connecting the inner base segment, the anterior base segment, the outer base segment and the posterior base segment at the junction of the lung base and the boundary between the base segment and the anterior base segment at the inner edge of the bottom edge and the inner line of the bottom edge It is 90 degrees.
  5. 一种肺段模型的制备方法，其特征在于：步骤如下：测量肺可识别的解剖结构的数据，制备肺模型，然后根据实施例1～4任意一项方法确定的段间标志点的位置，在肺模型上安装每个段间标志点。A method for preparing a lung segment model, characterized in that the steps are as follows: measuring data of an anatomical structure recognizable by the lung, preparing a lung model, and then determining the position of the marker point between the segments according to any one of the embodiments 1 to 4. Install each inter-segment marker on the lung model.
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