中国临床医学2025，Vol.32Issue(5)：748-754,7.DOI:10.12025/j.issn.1008-6358.2025.20250225
基于CT门静脉血管成像的3D可视化内镜导航系统精准治疗食管胃静脉曲张的疗效分析
Efficacy analysis of precise treatment of esophageal and gastric varices using a 3D visualization endoscopic navigation system based on CT portal angiology
摘要
Abstract
Objective To develop a 3D visualization endoscopic navigation system based on CT portal angiography(CTPA)and explore its clinical value in assisting precise treatment of esophageal and gastric varices(EGV).Methods Patients with EGV needing treatment in the Department of Gastroenterology of Zhongshan Hospital,Fudan University from September 2021 to April 2023 were collected.Preoperative examinations including CTPA and hematological examinations were performed,and a 3D visualization endoscopic navigation system was developed to assist endoscopic treatment.Real time comparison was made between the endoscopic 3D portal vein system image reconstructed by intelligent imaging and the actual endoscopic observation of the vascular morphology inside the cavity.The responsible blood vessels that are prone to bleeding were embolized using a sandwich injection method of"lauromacrogol+tissue adhesive+lauromacrogol".For patients with portal shunting,ultrasound-guided coil insertion was performed.Postoperative endoscopic ultrasound or CTPA was used reexamination to evaluate vascular embolism and complications.Results A total of 13 patients successfully underwent endoscopic ultrasound-guided variceal embolization.The average maximum inner diameter of target veins was(3.3 1.3)cm;on average,implanted coil number was 1(0,2)in each patient,with median dosages of lauromacrogol and tissue adhesive were 9.5(7.8,10.0)mL and 1.5(1.0,2.1)mL respectively.Postoperatively,endoscopic ultrasound detecting confirmed complete occlusion of all target veins.At 8 weeks after treatment,none of the patients experienced rebleeding.At 24 weeks after treatment,rebleeding occurred in 3 patients,on postoperative days 107,126 and 147,respectively.Conclusion The 3D visualization endoscopic navigation system based on CTPA can effectively and safely assist preoperative diagnosis and intraoperative localization of target blood vessels,which is beneficial for the precise treatment of EGV patients.关键词
食管胃静脉曲张/门静脉高压/CT门静脉血管成像/三维可视化技术Key words
esophageal and gastric varices/portal hypertension/CT portal angiology/three dimensional visualization technique分类
医药卫生引用本文复制引用
付钰,黄晓铨,王剑,加依娜尔·波拉提汗,王艳芳,袁棱畅,马丽黎..基于CT门静脉血管成像的3D可视化内镜导航系统精准治疗食管胃静脉曲张的疗效分析[J].中国临床医学,2025,32(5):748-754,7.基金项目
上海市"科技创新行动计划"自然科学基金(21ZR1447600).Supported by Natural Science Foundation of Shanghai Science and Technology Innovation Action Plan(21ZR1447600). （21ZR1447600）
