【作者】 宋跃帅；

【导师】 韩东一；

【作者基本信息】 南开大学 ， 外科学， 2012， 博士

【摘要】 背景：耳显微外科所涉及的解剖结构基本都深藏于颞骨中，自身体积细小精微，形态多变而不规整。此外，许多颞骨内的结构，如：面神经、颈内动脉、颈内静脉、乙状窦等，行程绵延曲折、空间跨度较大，且与颅底、颅内、腮腺、上颈部等周围区域内的结构或直接沿续、或位置关系密切。因而，人们对耳显微外科所涉及的解剖结构常常是触之不及、窥之不见，难以建立直观、形象而具体的空间感受，学习和熟练掌握的难度较大。此外，目前应用于耳显微外科临床及解剖的图片及视频基本都是二维的，而在实际的临床工作中，术者所看到的真实术野是具有丰富的立体信息的。相对于原始的立体术野，二维媒体丢失了许多关键的立体信息，这些立体信息在辨识解剖结构、确定解剖方位等方面非常重要，当手术中遇到因出血或正常结构被破坏而导致解剖标志不清时这些立体信息尤为重要。因此，如何以恰当的方式保存和再现原始术野的立体信息，如何以最佳的角度展示耳显微外科涉及的解剖结构和解剖操作过程，是本课题需要解决的两个主要问题。目的：探索将立体视觉技术应用于耳显微外科的方法；探索以立体的表现形式展示颞骨内解剖结构及解剖操作的方法。方法：调查研究现有的多种立体视觉重建解决方案，并结合耳显微外科临床工作特点筛选可以应用于耳显微外科的立体视觉重建解决方案；在解剖及手术工作中验证选定的立体视觉重建解决方案的可行性，并对最终选定的解决方案进行规范化、流程化处理；开展规范的、系统的颞骨解剖，并按规范化流程采集并制作颞骨解剖和颞骨三维重建的立体素材，并通过合适的方式重现原始术野的立体信息。结果：我们成功的将立体视觉技术应用于耳显微外科，制定了适用于耳显微外科、并可推广至其他相关领域的立体视觉重建解决方案。基于此方案，我们对耳显微外科立体视觉重建系统所涉及的设备、软件、采集及制作方法等各个部分都进行了规范化、系统化处理，形成了与耳显微外科立体视觉重建方案相匹配的软、硬件系统。我们按规范化的流程采集了1.2万余幅颞骨解剖及颞骨三维重建素材，制作了624幅高质量的颞骨解剖和颞骨三维重建立体图，而且这些立体图可以源源不断的增加并能保持持续更新，从而使耳显微外科立体视觉重建系统具备了临床实用价值。在现有技术手段基础上，我们还进一步探索性的开发了耳显微外科立体电视监视系统，目前该系统已实现本地及局域网内的立体实时监控，初步显现出其临床实用价值。结论：耳显微外科立体视觉技术可以应用于耳显微外科。耳显微外科立体视觉信息重建系统集成度高、操作简单、并能够很好的保存并重现原始术野的立体信息。耳显微外科立体视觉重建解决方案具备相当的临床实用价值。更多还原

【Abstract】 Background: Anatomic structures in temporal bone are so tiny and deeplylocated that they are hardly to be touched or observed. Besides, anatomic structures intemporal bone, such as facial nerve, internal carotid artery and sigmoid sinus, have awide association with the anatomic structures in the area of basicranial, entocranial,parotid gland and upper neck. So it is hard for begininers to get a visualizedthree-dimensional sensation of these anatomic structures in temporal bone. Andsurgical fields shown with binocular microscope are three-dimensional in the mocroear surgery, surgeons can obtain stereoscopic information of the surgical field.However in most hospitals only surgeon and chief assistant can obtain stereoscopicinformation of surgical field during surgery, because of the limitation of the stereoequipments. Besides, stereoscopic information of micro ear surgery is also difficult tocapture and process. Until now, most operating room (OR) staff and people outsidethe hospital can only view two-dimensional (2D) videos and images from micro earsurgery. Compared to a true stereoscopic surgical field,2D media may lose someuseful three-dimensional (3D) information. In addition, inexperienced users may beconfused and obtain incorrect information from these2D videos and images.Objective: To explore methods of capture and process stereoscopic imformationfrom micro ear surgery. To explore a novel approach to demonstrate anatomicstructures and operation procedures in temporal bone with stereoscopic images.Materials and Methods: Stereoscopic reconstruction methods were reviewed.Methods of stereoscopic information reconstruction were slected to apply in microear surgery. Then the method was re-checked in clinical and anatomic practice.Besides, a great number of stereoscopic materials were processed, and stereoscopicmaterials were successfully used to re-build stereoscopic image of surgical fields.Results: Stereoscopic technique was successfully applied in micro ear surgery.The stereoscopic reconstruction system was built to process stereoscopic informationof micro ear surgery. The working flow and quality control standards of processstereoscopic information of micro ear surgery was defined in detail. A database of 12,000pieces of original photos of temporal bone anatomy were captured, and acollection of624pieces of paired stereoscopic images were processed according tothe working flow. Moreover, the amount of paired stereoscopic images can beincreased and images can also be updated continuously. Besides, the stereoscopicmonitoring system based on binocular operating microscope was made, realtime localmonitoring and remote live online of surgical fields can be achived preliminarily.Conclusions: Stereoscopic techinique is feasible in micro ear surgery.Stereoscopic information reconstruction system was highly intergrated and easy touse, and the original stereoscopic information of surgical fields can be collected andrebuilt in highly quality. The stereoscopic reconstruction methods is valueable inmicro ear surgery.更多还原