A method and apparatus for surgical planning of safe ablation of prostate hyperplasia

Abstract

The application provides a surgical planning method and device for safe ablation of benign prostatic hyperplasia. First, a preoperative three-dimensional image containing the entire prostate structure of a patient is acquired, and a key tissue contour is identified. Based on the key tissue contour, a plurality of ablation schemes are fitted, wherein each ablation scheme contains at least one spherical region, the sum of the volumes of the at least one spherical region in each ablation scheme is calculated, and the ablation scheme with the largest sum of volumes is selected as a reference scheme. An intraoperative real-time ultrasound image containing the entire prostate structure of the patient is acquired, the key tissue contour in the intraoperative real-time ultrasound image is identified, and a deformation degree coefficient is determined. Further, based on the deformation degree coefficient and the reference scheme, a planning scheme is determined. The application can effectively provide sexual function protection for the patient, and take into account the surgical efficiency and safety.

Description

TECHNICAL FIELD

[0001] The present application relates to the technical field of medical devices, in particular to a surgical planning method and device for safe ablation of benign prostatic hyperplasia. BACKGROUND

[0002] Benign prostatic hyperplasia (BPH) is the most common benign disease causing urinary dysfunction in middle-aged and elderly men, and is one of the most common diseases in global urological clinical diagnosis and treatment. It is mainly manifested as histological prostatic interstitial and glandular component hyperplasia, anatomical prostatic enlargement (BPE), bladder outlet obstruction (BOO), and clinical symptoms mainly including lower urinary tract symptoms (LUTS). The incidence of BPH increases with age in epidemiological histology, generally occurring after the age of 40. The incidence of BPH in the male population of 60 years old is greater than 50%, and it reaches 83% at the age of 80. In an aging longitudinal study, it was found that the prostate volume of the study population increased at a median rate of 0.6 mL per year. Larger prostate volume is associated with increased risk of urinary retention, surgical demand, and BPH-related complications.

[0003] In the past 30 years, minimally invasive surgery for BPH has made great progress and has become the first choice for the treatment of patients with moderate to severe BPH. However, although minimally invasive surgery significantly improves the patient's LUTS symptoms, reduces surgical complications, and improves surgical safety, it is still not very satisfactory in terms of postoperative sexual function preservation and recovery. At present, various surgeries, such as bladder neck, tissue between bladder neck and verumontanum, verumontanum, and ejaculatory ducts on both sides of the verumontanum, are extremely vulnerable to damage. Damage to these tissues directly causes postoperative erectile dysfunction and ejaculatory dysfunction in patients.

[0004] Therefore, how to design a safe surgical planning scheme for the special needs of prostatic hyperplasia surgery to maximize the improvement of the patient's quality of life has become a technical problem to be solved. SUMMARY

[0005] The present application is proposed to solve the above problems in the prior art. The present application provides a surgical planning method for safe ablation of benign prostatic hyperplasia, comprising the following steps:

[0006] Obtaining a preoperative three-dimensional image containing all the prostate structures of a patient, and identifying the key tissue contours in the preoperative three-dimensional image using an image segmentation algorithm;

[0007] fitting a plurality of ablation schemes based on the key tissue contours, wherein each of the ablation schemes comprises at least one spherical region, calculating a sum of volumes of the at least one spherical region in each of the ablation schemes, and selecting an ablation scheme with a largest sum of volumes as a reference scheme;

[0008] acquiring an intraoperative real-time ultrasound image containing all prostate structures of the patient, identifying key tissue contours in the intraoperative real-time ultrasound image using an image segmentation algorithm, and determining a deformation degree coefficient based on the key tissue contours in the preoperative image and the key tissue contours in the intraoperative real-time ultrasound image, and further determining a planning scheme based on the deformation degree coefficient and the reference scheme.

[0009] As a preference, the key tissue is a left lobe, a right lobe and / or a middle lobe of the prostate structure.

[0010] As a preference, each of the ablation schemes comprises at least one spherical region, and any spherical region and its corresponding needle-out trajectory do not intersect with the region of the verumontanum.

[0011] As a preference, in each of the ablation schemes, the center of any spherical region is not within another spherical region.

[0012] Further as a preference, the reference scheme is also selected according to an ablation effect function, wherein the ablation effect function f = a1*(V1 / Vtotal)-a2*Onum+a3*Lsafe, wherein a1, a2, a3 are coefficients representing weights, V1 is a sum of volumes of the spherical regions in the evaluated ablation scheme, Vtotal is the overall volume of the part of the prostate of the patient, Onum represents the number of needle-outs, and Lsafe is a distance between a straight line of the needle-out trajectory closest to the safe bounding box and the center of the safe bounding box.

[0013] As a preference, the method further comprises: acquiring an intraoperative real-time ultrasound sagittal plane image, identifying a prostate middle lobe contour and a bladder neck contour in the sagittal plane image, and determining whether the prostate middle lobe contour and the bladder neck contour overlap in a horizontal direction, and when there is an overlap, the planning scheme comprises an ablation scheme for the prostate middle lobe.

[0014] The application also provides a surgical planning device for safe ablation of prostate hyperplasia, comprising the following modules:

[0015] an image and contour acquisition module for acquiring a preoperative three-dimensional image containing all prostate structures of the patient, and identifying key tissue contours in the preoperative three-dimensional image using an image segmentation algorithm;

[0016] a reference scheme determination module configured to fit a plurality of ablation schemes based on the key tissue contour, wherein each of the ablation schemes comprises at least one spherical region, wherein the center of each spherical region in any of the ablation schemes is not within another spherical region, calculate the sum of the volumes of the at least one spherical region in each of the ablation schemes, and select the ablation scheme with the largest sum of the volumes as the reference scheme;

[0017] a planning scheme determination module configured to acquire an intraoperative real-time ultrasound image containing all prostate structures of the patient, identify the key tissue contour using an image segmentation algorithm, and determine a deformation coefficient based on the key tissue contour in the preoperative image and the key tissue contour in the intraoperative real-time ultrasound image, and further determine a planning scheme based on the deformation coefficient and the reference scheme.

[0018] The application also provides an electronic device, comprising a memory, a processor, and a computer program stored in the memory and executable on the processor, wherein the computer program, when executed by the processor, implements the method according to any one of the embodiments of the first aspect of the application.

[0019] The application also provides a computer readable medium, wherein a computer program is stored on the computer readable medium, and the computer program, when executed by a processor, implements the method according to any one of the embodiments of the first aspect of the application.

[0020] The above at least one technical scheme adopted by the embodiments of the application can achieve the following beneficial effects: The application adopts a combination of preoperative and intraoperative images, performs image recognition on the special structure of the prostate hyperplasia, and sets the ablation scheme fitting in the region defined by the recognized key tissue contour, so that the planning scheme of the ablation range of the prostate hyperplasia tissue can not only improve postoperative urination, but also provide improved protection of sexual function; By setting the center of any spherical region in each ablation scheme not within another spherical region, it can be ensured that the planned multiple spherical regions can achieve better ablation effect; Based on the reference scheme planned based on the preoperative three-dimensional image, the planning scheme is adjusted by combining the coefficient conversion with the intraoperative ultrasound image, so that more accurate and objective guidance can be provided for the actual operation of the operator. The application can work cooperatively with a prostate hyperplasia robot ablation system, and the energy platform can use water vapor. The application can improve the surgical efficiency, shorten the operation time, and reduce the work intensity of medical personnel. More importantly, the surgical planning method and device for prostate hyperplasia ablation provided by the application can effectively protect the sexual function of the patient and minimize the incidence of postoperative erectile dysfunction and ejaculatory dysfunction. BRIEF DESCRIPTION OF DRAWINGS

[0021] The accompanying drawings, which are included to provide a further understanding of the application and are incorporated in and constitute a part of this application, illustrate embodiments of the application and together with the description serve to explain the application. In the drawings:

[0022] Figure 1 Flowchart of the method according to an embodiment of the application.

[0023] Figure 2 Schematic diagram of the cross-sectional anatomy of the prostate applicable to an embodiment of the application.

[0024] Figure 3 Schematic diagram of the needle of a vapor ablation needle applicable to an embodiment of the application.

[0025] Figure 4 Schematic diagram of the position relationship between the vapor ablation needle and the image contour in the cross-sectional image according to an embodiment of the application.

[0026] Figure 5 Schematic diagram of the fitting of a plurality of vapor needle ablation ranges in the cross-sectional image according to an embodiment of the application.

[0027] FIG. 6(a) is a schematic diagram of the situation where the fitted spherical regions overlap in the cross-sectional image.

[0028] FIG. 6(b) is a schematic diagram of the situation where the fitted spherical regions do not overlap in the cross-sectional image. DETAILED DESCRIPTION

[0029] In order to make the objects, technical solutions and advantages of the application clearer, the technical solutions of the application will be described below in detail with reference to the embodiments of the application and the accompanying drawings. Obviously, the described embodiments are only some of the embodiments of the application, but not all the embodiments of the application. Based on the embodiments in the application, all other embodiments obtained by those of ordinary skill in the art without creative work fall within the scope of protection of the application.

[0030] The technical solutions provided by the embodiments of the application will be described in detail below with reference to the accompanying drawings.

[0031] The application provides a surgical planning method for safe ablation of prostate hyperplasia, and the specific steps of the method are described in detail as follows:

[0032] First, a preoperative three-dimensional image containing the entire prostate structure of a patient is obtained, and an image segmentation algorithm is used to identify the key tissue contour in the preoperative three-dimensional image.

[0033] The acquired preoperative three-dimensional image can be various images that can clearly reflect the structure of the prostate of the patient, can be a three-dimensional ultrasound image, and the preoperative three-dimensional ultrasound image can be acquired in a transabdominal or transrectal or transurethral manner. The obtained three-dimensional ultrasound image can clearly show the shape, contour, size, position and echo change of the prostate. On the other hand, the acquired preoperative three-dimensional image can also be a three-dimensional magnetic resonance image. Since the acquisition time and / or location of the preoperative image is not limited, a three-dimensional magnetic resonance image is preferably acquired to provide better soft tissue resolution and spatial resolution for the prostate.

[0034] Further, the acquired three-dimensional image is segmented by an image segmentation algorithm to segment the contour of the key tissue contained therein. It should be understood that the image segmentation algorithm is a relatively mature technology in the prior art, and a suitable image segmentation algorithm can be selected according to the efficiency and other requirements, such as threshold segmentation, edge detection, or deep learning (Deep Learning), U-NET network-based, Active Contour, Level Set, Region-Based Segmentation, Boundary-Based Segmentation, etc.

[0035] It should be noted that in the present application, the preoperative three-dimensional image can be a directly acquired three-dimensional image, or a three-dimensional image obtained by three-dimensional reconstruction from a series of two-dimensional images. The use of an image segmentation algorithm to identify the tissue contour in the preoperative three-dimensional image can be three-dimensional image segmentation of the three-dimensional image to obtain a three-dimensional contour, or two-dimensional image segmentation of the two-dimensional image of the three-dimensional image slice to obtain a two-dimensional contour, and three-dimensional reconstruction of the two-dimensional contour to obtain a three-dimensional key tissue contour.

[0036] Referring to Figure 2 The lobes of the prostate are divided according to the position and shape of the prostate, and the prostate is divided into a front lobe, a middle lobe, a rear lobe and left and right side lobes. The front lobe is small and located in front of the urethral prostatic part. The middle lobe is located between the urethral prostatic part and the ejaculatory duct and is one of the prone sites of prostate hypertrophy in elderly men. The rear lobe is located behind the middle lobe and the left and right side lobes and is a prone site of prostate tumor. The left and right side lobes are located on the left and right sides of the urethral prostatic part, the middle lobe and the front lobe, and the left and right side lobes and the middle lobe are prone sites of prostate hypertrophy in elderly men. The key tissue at least includes the left and right side lobes of the prostate. In the preferred embodiment, the key tissue can also include the middle lobe of the prostate, the bladder mouth, the verumontanum and the prostate urethra.

[0037] After the above steps are completed, based on the key tissue contour, a plurality of sets of ablation schemes are fitted, each set of ablation schemes including at least one spherical region, the sum of the volumes of the at least one spherical region in each set of ablation schemes is calculated, and the ablation scheme with the largest sum of volumes is selected as the reference scheme.

[0038] First, regarding the ablation region model. The planning method and device proposed in the present application are suitable for surgical methods of releasing energy by energy sources to ablate target tissues, and are particularly suitable for schemes of using steam to ablate hyperplastic tissues of the prostate. The steam is released by, for example, a steam ablation needle, heat convection is generated in the surrounding tissues, and the heat energy generated by the sterile high-temperature steam causes the prostate tissue cells to denature and necrose, thereby achieving the effect of reducing the volume of the prostate. See Figure 3 , considering that steam ablation is heat convection, the temperature field model of the ellipsoidal region is the same temperature in the ellipsoidal region. When the steam temperature is constant, the long axis of the ellipsoidal temperature field model is controlled by the steam pressure intensity and time, and the short axis is determined by the number of steam release holes in the axial direction of the needle length of the steam needle. As shown in the left side of the figure, when three holes release steam at the same time, the short axis of the ellipsoidal temperature field model is longer than when two holes release steam at the same time. By controlling the steam pressure and the number of steam release holes, the ablation range of the ellipsoidal temperature field model can be controlled. Therefore, the ablation region model is defined as a sphere. It should be noted that the steam described in the present application includes but is not limited to water vapor (steam), and can also be other ablation media in gaseous state / gas-liquid two-phase state.

[0039] Further, based on the defined spherical ablation region model and the key tissue contour identified in the foregoing steps, a plurality of sets of ablation schemes are fitted.

[0040] In the basic embodiment, at least based on the left lobe contour and the right lobe contour of the prostate, spherical fitting is performed, and the specific fitting scheme is described in detail below taking the left lobe as an example.

[0041] In the present application, the identified key tissue contour is a closed graph, and based on the identified key tissue contour, it is also understood to be within the contour graph within the region defined by the closed graph of the identified key tissue contour. Since the left lobe and the right lobe of the prostate are located in the region far from the sensitive region and prone to hyperplasia, ablation within the left lobe contour graph and / or the right lobe contour graph can provide improved and safe hyperplasia ablation.

[0042] Referring to Figure 4 , the XYZ coordinate system is the coordinate system of the preoperative three-dimensional image, the S axis is the axial channel established by inserting the steam ablation needle along the urethra, and the S1, S2, S3, S4, etc. The position of the S axis where the cross section is located is the steam needle treatment point coordinate, that is, a plurality of treatment point positions can be selected along the urethral axis as the treatment position origin of the steam needle.

[0043] like Figure 5 As shown, the contours of the left and right lobes of the prostate, as well as key tissues such as the urethra, bladder, and seminal colliculus, have been segmented from the 3D image. These contours can be converted into pixel coordinates in the 3D image coordinate system and displayed in various 2D images. In this embodiment, the axis position after the steam needle is inserted should be at the urethra. The prostatic urethral contour appears approximately flattened ellipse in the cross-sectional image. Since the prostatic urethral contour is expanded into an approximately circular shape by inserting a steam needle through a sheath during the procedure, the prostatic urethral contour can be fitted as a circle in the planning process. The axis position is the location of the fitted circle's center, i.e., the steam needle exit position in the S-axis section image. With the steam needle insertion position as the origin, the steam needle can rotate an angle and exit a certain length to reach the designated position. At the designated position, steam is released through the steam needle outlet to complete the ablation treatment. Figure 4 The diagram shows four ablation zones achieved by the vapor needle at the same origin position with four different rotation angles and extension lengths. Each ablation zone is designed as a spherical area.

[0044] like Figure 5 The illustrated embodiment provides an ablation scheme comprising four spherical regions in the left lobe of the prostate. However, it should be understood that the number of spherical regions is not limited to four; preferably, the number is 2-5. Generally, for patients with larger prostate volumes, a greater number of spherical regions is preferred, while for patients with smaller prostate volumes, a smaller number is selected. In cases involving multiple spherical regions, whether the regions have equal or unequal diameters does not affect the achievement of the objective of this application. For a more precise planning scheme, the multiple spherical regions can be designed with unequal diameters; for a more efficient planning scheme, the multiple spherical regions can be designed with equal diameters.

[0045] Furthermore, such as Figure 5The illustrated can provide multiple sets of ablation schemes, each set of ablation schemes containing at least one spherical region; the sum of the volumes of the at least one spherical region in each set of ablation schemes is calculated, and the ablation scheme with the largest sum of volumes is selected as the reference scheme. In a specific implementation, an optimization algorithm such as a genetic algorithm, a simulated annealing algorithm, etc. can be used to solve this problem. In a preferred embodiment, a certain number of treatment points are first randomly generated in the initial stage, and a spherical ablation region corresponding to each treatment point is generated with the treatment point as the center of the sphere. An ablation effect function is defined, which can evaluate the treatment effect of the combination of the spherical ablation regions corresponding to the treatment points. Factors to be considered when defining the ablation effect function include coverage, treatment uniformity, potential side effects, and the weights of the above factors. The ablation effect function value of the combination of the randomly generated treatment points and their spherical ablation regions is calculated. Then, the number, position, and radius of the treatment points and the spherical ablation regions are continuously adjusted through an iterative process to improve the value of the ablation effect function. Through the iterative process, when a predetermined convergence condition is reached, i.e., the value of the ablation effect function changes little in continuous iterations or reaches a preset threshold, the algorithm stops iteration, and thus the treatment point plan obtained when the iteration converges to obtain the final optimal ablation effect value is obtained as the reference scheme. In this embodiment, the ablation effect function is positively correlated with the sum of the volumes of the spherical regions. In a preferred embodiment, the ablation effect function gives a larger weight to the coverage, so that the ablation scheme that achieves a larger ablation volume is preferred.

[0046] According to the foregoing embodiments, when the ablation scheme with the largest sum of volumes is selected, the largest volume of the prostate hyperplasia tissue can be ablated, thereby effectively reducing the volume of the hyperplasia tissue and improving the urination symptoms after the operation. At the same time, by limiting the ablation scheme planning within the region defined by the contour of the left or right lobe of the prostate, the ablation range can be limited to the hyperplasia-prone site and away from the verumontanum and ejaculatory duct region, thereby providing basic protection for the sexual function of the patient.

[0047] In a preferred embodiment, a constraint condition can also be added to the planning: each set of ablation schemes contains at least one spherical region, and any spherical region and its corresponding needle-out trajectory have no intersection with the verumontanum region. In this embodiment, the contour of the key tissue identified also contains the verumontanum part. Considering that the verumontanum has a small volume and is easily moved by the surrounding tissue, the verumontanum region is defined as an enlarged region centered on the verumontanum part. As an example, the verumontanum region can be expressed as a spherical bounding box that surrounds the verumontanum part, which is also called a safe bounding box. The center point coordinate of the bounding box is safe_center, and the radius is safe_r.

[0048] Referring to Figure 5Figure 6(a) shows the vapor needle ablation range 1, vapor needle ablation range 2, vapor needle ablation range 3, vapor needle ablation range 4 generated according to one ablation scheme, the four vapor needle ablation ranges are four spherical regions respectively, each spherical region contains a spherical center, the ray defined from the fitting circle center P of the urethra to the spherical center of the spherical region is the needle exit trajectory. In this embodiment, any spherical region has no intersection with the region of the bulb of the penis to ensure that the planned ablation region will not touch the region of the bulb of the penis; and the needle exit trajectory corresponding to any spherical region also has no intersection with the region of the bulb of the penis to ensure that the process of exiting the needle from the urethral site to the center of the ablation region will not touch the region of the bulb of the penis, providing more perfect protection. In the case of setting this constraint condition, the algorithm or system judges each ablation scheme for this constraint condition, when the constraint condition is not met, that is, when any spherical region or the needle exit trajectory corresponding to any spherical region has intersection with the region of the bulb of the penis, then regardless of its ablation effect function value, the ablation scheme is excluded.

[0049] Considering that the vapor ablation scheme needs to implement ablation through the principle of convection through intercellular gaps, rather than simple heat conduction, therefore, the dead cells can affect the convection effect, therefore, in the preferred embodiment, the planned constraint condition is also increased: the next treatment point is not in the previous treatment region, as shown in Figure 6(a), in which P is the needle exit position, and the spherical center of the vapor needle ablation range 3 defined by r3 is located in the spherical region of the vapor needle ablation range 2 defined by r2, which is not desirable, because when the operation is performed, the ablation in the vapor needle ablation range 2 defined by r2 is performed first, the tissue in the spherical region thereof is theoretically dead, when the next treatment point is r3 shown in the figure, the tissue at the insertion position of the vapor needle represented by the spherical center has necrosis, and the released vapor is difficult to implement ablation through the principle of convection through intercellular gaps, which will affect the ablation effect, and experiments show that the actual ablation range is no longer an approximate spherical region, resulting in a large deviation between the actual scheme and the planned scheme.

[0050] It should be noted that the above problem cannot be solved even if the needle replacement order is changed, because while the center of the spherical region of the vapor needle ablation range 3 defined by r3 is located within the spherical region of the vapor needle ablation range 2 defined by r2, the center of the spherical region of the vapor needle ablation range 2 defined by r2 is also located within the spherical region of the vapor needle ablation range 3 defined by r3, which means that even if the ablation within the vapor needle ablation range 3 defined by r3 is performed first, when the next treatment point is r2 shown in the figure, the tissue at the insertion position of the vapor needle represented by the center of the spherical region has already been necrotic, and the released vapor is still difficult to implement ablation by the principle of convection through the intercellular space, which will also affect the ablation effect. Therefore, the added constraint condition can also be expressed as: the center of any spherical region is not within other spherical regions. As shown in FIG. 6(b), the centers of the spherical regions of the four vapor needle ablation ranges defined by r1, r2, r3 and r4 are not within other spherical regions, so that the vapor ablation effect can be ensured. Therefore, under the condition of setting this constraint condition, the algorithm or system performs the constraint condition judgment and iterative calculation of the objective function for each ablation scheme, and when the constraint condition is not met, that is, when one treatment point is within the region of another treatment point, the ablation scheme is excluded or the recommendation degree of the ablation scheme is reduced. In this way, it can be ensured that each spherical region in the planned ablation scheme can achieve efficient ablation effect, thereby reducing or avoiding the occurrence of inefficient ablation or ineffective ablation.

[0051] The foregoing scheme takes into account the influence of the convection principle of vapor ablation through the intercellular space, but it should be noted that vapor ablation itself still generates heat energy, and the conducted released heat energy will also have a certain impact on the surrounding tissue, so the influence of the heat conduction effect of the ablation boundary on the surrounding tissue also needs to be considered, so in the preferred embodiment, a safety reserved surrounding layer is added to the periphery of each spherical region, and the radius increment defined by the safety reserved surrounding layer is safe_deltaR. The radius increment can be a preset value, or can be determined experimentally according to the ablation energy, tissue characteristics and expected heat conduction range.

[0052] In a preferred solution, all the foregoing constraints are considered, and the foregoing constraints are constructed into a function in a manner of describable parameters and weights, specifically, an ablation effect function f=a1*(V1 / Vtotal)-a2*Onum+a3*Lsafe can be set, the ablation effect function is used to evaluate the ablation effect of each group of ablation schemes, wherein a1, a2, a3 are coefficients representing weights, V1 is the sum of the volumes of the spherical regions in the evaluated group of ablation schemes, Vtotal is the overall volume of the part of the prostate of the patient, Onum represents the number of needle times, and Lsafe is the distance between the straight line of the needle trajectory closest to the safe bounding box and the center of the safe bounding box. The ablation effect function is designed to take into account coverage, safety, and efficiency. According to the ablation effect function, the volume of the ablation region should be as close to the volume to be ablated as possible, that is, the larger the sum of the volumes of the spherical regions in a group of ablation schemes, the more preferred, to obtain a larger volume of resection and provide improved urination for the patient after surgery. At the same time, the fewer the number of treatment needles used, the better, when the number of treatment needles is small, it can ensure that the overlap of each treatment region is low, providing more effective ablation, and can effectively promote the recovery of the patient after surgery; the farther the distance from the key safety area, the better, the farther the distance between the straight line of the needle trajectory and the center of the safe bounding box, the lower the risk of damaging the key area, thereby providing a safer effect. Accordingly, the ablation effect of each group of ablation schemes is evaluated according to the ablation effect function defined above under the condition of meeting the foregoing constraints, and the larger the ablation effect value, the better.

[0053] In the evaluation of the ablation effect and the determination of the ablation scheme, the lateral lobe and / or the median lobe of the prostate are targeted, wherein the evaluation and selection of the scheme can be performed for the left lateral lobe, the right lateral lobe, and the median lobe of the prostate respectively, or the evaluation and selection of the scheme can be performed for the left lateral lobe, the right lateral lobe, and the median lobe of the prostate jointly.

[0054] It should be noted that although the above embodiments are described by inserting the vapor ablation needle along the urethra, the scheme of the present application is not limited to insertion along the urethra, and insertion of the ablation needle through other channels (such as transperineal) is also possible, because the present application is not limited to the conversion of specific ablation mode parameters, but only involves planning based on image information. Those skilled in the art can convert the planning scheme into a specific surgical execution scheme according to various existing methods such as coordinate conversion, etc.

[0055] In the following steps, further, an intraoperative real-time ultrasound image containing the entire prostate structure of the patient is obtained, the contours of the lateral lobe and / or the median lobe of the prostate are identified using an image segmentation algorithm, and a deformation coefficient is determined based on the contours of the lateral lobe and / or the median lobe of the prostate in the preoperative image and the contours of the lateral lobe and / or the median lobe of the prostate in the intraoperative real-time ultrasound image.

[0056] It should be noted that the deformation degree coefficient not only includes a single numerical value, but also can be embodied as a matrix. For example, based on image feature points on the key tissue contour in two images, a deformation degree coefficient conversion matrix can be determined using elastic registration or the like.

[0057] For the prostate structure, when performing a minimally invasive ablation surgery, for example, an execution mechanism of a vapor ablation needle needs to be guided to the prostate area through the urethra. Due to the deformation and position shift of the surrounding soft tissue during the movement of the execution mechanism, the actual tissue contour in the surgery is greatly shifted compared with the tissue contour in the preoperative three-dimensional image, which makes the preoperative planning scheme not directly applicable. Therefore, according to an embodiment of the present application, a real-time intraoperative ultrasound image containing the entire prostate structure of the patient is preferably obtained, which can be a real-time three-dimensional ultrasound image, or a set of sagittal plane images and transverse plane images obtained by a biplane ultrasound probe; it should be understood that a three-dimensional ultrasound image can also be reconstructed from the set of sagittal plane images or the set of transverse plane images.

[0058] For the real-time three-dimensional ultrasound image, an image segmentation algorithm is used to identify the contour of the lateral lobe and / or the median lobe of the prostate, and the image segmentation algorithm is as described above. Moreover, the deformation degree coefficient is determined based on the contour of the lateral lobe and / or the median lobe of the prostate in the preoperative image and the contour of the lateral lobe and / or the median lobe of the prostate in the real-time intraoperative ultrasound image. It should be noted that when calculating the deformation degree coefficient, the preoperative image and the intraoperative image are preferably calibrated or registered so as to be in the same coordinate system for comparison and calculation. The calculation of the deformation degree coefficient can be performed in a manner such as Fourier descriptor, Hausdorff distance, or the like.

[0059] After the deformation degree coefficient of the key tissue contour is determined, the planning scheme can be determined based on the deformation degree coefficient and the reference scheme.

[0060] For patients with a large volume of prostate hyperplasia, the prostate hyperplasia can occur in the median lobe, and therefore the ablation surgery planning preferably includes an ablation planning scheme for the median lobe. The specific planning steps are similar to the foregoing steps, and the difference is that the identified tissue contour is the tissue contour of the median lobe of the prostate.

[0061] For conventional prostate hyperplasia ablation or resection surgery, resection of the middle lobe can face greater safety risks and special difficulties because the middle lobe is closer to the verumontanum region, and for the swollen middle lobe, it can protrude into the bladder neck and hang, making it difficult to resect or ablate and easily injure the tissue around the bladder neck, thereby affecting postoperative recovery. The planning method of the present application can effectively solve the above problems, because by inserting the vapor ablation needle into the middle lobe tissue according to the planning scheme and performing ablation, it is an easy-to-implement instrument execution mode, and the ablation area executed according to the planning scheme provided by the present application can perfectly avoid sensitive area tissues such as the verumontanum and vas deferens, and in addition, due to the vapor heat convection effect starting from the center of the spherical area, under a reasonable planning scheme, the vapor action range will not touch the bladder neck. Therefore, for the case of large hyperplasia of the middle lobe, especially for the case of the middle lobe hyperplasia tissue protruding into the bladder neck, the ablation area should be planned according to the middle lobe contour and executed to achieve a surgical plan that takes into account the ablation rate and safety, thereby providing improved urination function and sexual function protection for the patient after surgery.

[0062] In particular, the real-time intraoperative ultrasound sagittal plane image of the patient is obtained, and the contour of the middle lobe of the prostate and the contour of the bladder neck in the sagittal plane image are identified, and it is judged whether the contour of the middle lobe of the prostate and the contour of the bladder neck overlap in the horizontal direction. When there is an overlap, it means that the hyperplasia of the middle lobe of the prostate is large, and the hyperplasia of the tissue has been forced to extend in the direction of the bladder lumen, which means that the tissue in the overlapping area is relatively stable in the bladder neck and causes stenosis. In this case, the planning scheme should include an ablation scheme for the middle lobe of the prostate, and based on the planning scheme provided by the present application, the surrounding bladder neck tissue and other sensitive tissues can be effectively and safely protected.

[0063] According to the embodiments of the present application, the present application further provides a surgical planning device for safe ablation of benign prostatic hyperplasia, comprising: an image and contour acquisition module, configured to acquire a preoperative three-dimensional image containing all prostate structures of a patient, and identify key tissue contours in the preoperative three-dimensional image by using an image segmentation algorithm; a reference scheme determination module, configured to fit a plurality of ablation schemes based on the key tissue contours, wherein each ablation scheme contains at least one spherical region, calculate the sum of the volumes of the at least one spherical region in each ablation scheme, and select the ablation scheme with the largest sum of volumes as the reference scheme; and a planning scheme determination module, configured to acquire an intraoperative real-time ultrasound image containing all prostate structures of the patient, identify the key tissue contours by using an image segmentation algorithm, and determine a deformation degree coefficient based on the key tissue contours in the preoperative image and the key tissue contours in the intraoperative real-time ultrasound image, preferably, determine a deformation degree coefficient conversion matrix based on image feature points on the key tissue contours in the two images by using an elastic registration method, and further determine a planning scheme in the intraoperative image based on the deformation degree coefficient conversion matrix and the preoperative reference scheme.

[0064] It should be noted that the above modules are divided according to the functions of the modules, and can be implemented according to the needs in the physical position, hardware and software / firmware architecture.

[0065] Through the foregoing embodiments, the method and device provided by the present application can give the best ablation range of the benign prostatic hyperplasia ablation guaranteeing the ablation rate and protecting the function, shorten the operation time, improve the operation efficiency, and reduce the work intensity of medical personnel. In particular, the present application not only takes into account the volume effect of the ablated tissue, but also can better achieve the protection of sexual function, and maximally reduce the incidence of postoperative erectile dysfunction and ejaculation dysfunction of patients, thereby providing help for realizing precise and safe surgery.

[0066] Those skilled in the art should understand that the embodiments of the present application can be provided as a method, a system, or a computer program product. Therefore, the present application can adopt a completely hardware embodiment, a completely software embodiment, or an embodiment combining software and hardware aspects. In one typical configuration, the device of the present application includes one or more processors (one of CPU, FGAP, MUC), an input / output user interface, a network interface, and a memory.

[0067] Therefore, the present application further provides an electronic device, comprising a memory, a processor, and a computer program stored in the memory and executable on the processor, wherein the computer program is executed by the processor to implement the method according to any one of the embodiments of the first aspect of the present application.

[0068] The computer program instructions can also be loaded onto a computer, other programmable data processing apparatus, or other processing device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other processing device to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions specified in the flowchart block or blocks. Figure 1 The computer program instructions can also be loaded onto a computer, other programmable data processing apparatus, or other processing device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other processing device to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions specified in the flowchart block or blocks. Figure 1 The computer program instructions can also be loaded onto a computer, other programmable data processing apparatus, or other processing device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other processing device to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions specified in the flowchart block or blocks.

[0069] These computer program instructions can also be stored in a computer readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer readable memory produce an article of manufacture including instructions which implement the function specified in the flowchart block or blocks. Figure 1 The computer program instructions can also be loaded onto a computer, other programmable data processing apparatus, or other processing device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other processing device to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions specified in the flowchart block or blocks. Figure 1 The computer program instructions can also be loaded onto a computer, other programmable data processing apparatus, or other processing device to cause a series of operational steps to be performed on the computer, other programmable apparatus or other processing device to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions specified in the flowchart block or blocks.

[0070] Moreover, the application can take the form of a computer program product on one or more computer readable storage media (including, but not limited to, disk memory, CD-ROM, optical storage medium, etc.) embodying computer readable program code.

[0071] Therefore, the application also provides a computer readable medium, having stored thereon computer program, which, when executed by a processor, implement the steps of the method according to any one of the embodiments of the application. For example, the memory of the application can include non-persistent memory in the computer readable medium, random access memory (RAM) and / or non-volatile memory, such as read only memory (ROM) or flash memory (flash RAM).

[0072] Computer-readable media includes permanent and non-permanent, movable and non-movable media that can implement information storage by any method or technology. The information can be computer-readable instructions, data structures, program modules or other data. Examples of computer storage media include, but are not limited to, phase-change memory (PRAM), static random access memory (SRAM), dynamic random access memory (DRAM), other types of random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory or other memory technologies, compact disc read-only memory (CD-ROM), digital versatile disc (DVD) or other optical storage, magnetic cassette, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other non-transmission medium that can be used to store information accessible to a computing device. According to the definition herein, computer-readable media does not include transitory media such as modulated data signals and carriers.

[0073] It should be noted that the terms "comprising", "including", or any other variant thereof are intended to cover a non-exclusive inclusion, such that a process, method, article or apparatus that comprises a list of elements does not only include those elements, but can also include other elements not expressly listed or inherent to such process, method, article or apparatus. Without more limitations, the element defined by the statement "comprising a" does not exclude the presence of additional identical elements in the process, method, article or apparatus that includes the element.

[0074] The above only describes the embodiments of the present application and is not intended to limit the present application. For those skilled in the art, the present application can have various changes and modifications. Any modification, equivalent replacement, improvement, etc. within the spirit and principle of the present application shall be included in the scope of claims of the present application.

Claims

1. A surgical planning method for vapor ablation of prostate hyperplasia, the method is adapted to perform ablation by utilizing the principle of vapor convection in the intercellular space, comprising the following steps: obtaining a preoperative image containing all prostate structures of a patient, and identifying key tissue contours in the preoperative image by using an image segmentation algorithm; determining a plurality of spherical regions in the preoperative image, wherein each spherical region is determined based on the number of vapor holes released by a vapor needle and the vapor pressure control of the vapor needle; each spherical region in each set of ablation schemes has a spherical center that is not in any other spherical region; calculating an ablation effect function for each set of ablation schemes, wherein the ablation effect function is determined based on the sum of the volumes of the spherical regions, the number of needle withdrawals, and a safety distance; obtaining a real-time intraoperative ultrasound image containing all prostate structures of the patient, identifying key tissue contours in the real-time intraoperative ultrasound image by using an image segmentation algorithm, and determining a deformation degree coefficient based on the key tissue contours in the preoperative image and the key tissue contours in the real-time intraoperative ultrasound image; and further determining a planning scheme based on the deformation degree coefficient and the reference scheme. Based on the key tissue contour identified in the preoperative image containing the entire prostate structure of the patient, the position of the center of the prostate urethral contour fitting is taken as the axis position, the position on the axial channel established by the steam needle insertion along the urethra is taken as the needle exit point, the steam needle insertion position is taken as the origin, and the steam needle ablation range is taken as the spherical region. Fit multiple groups of ablation schemes; wherein, The key tissue is a left lobe, a right lobe, and / or a middle lobe of the prostate structure. Each set of ablation schemes includes at least one spherical region, and any spherical region and its corresponding needle withdrawal trajectory have no intersection with a verumontanum region. The method further comprises: obtaining a real-time intraoperative ultrasound sagittal plane image, identifying a prostate middle lobe contour and a bladder neck contour in the sagittal plane image, and determining whether the prostate middle lobe contour and the bladder neck contour overlap in a horizontal direction; and when there is an overlap, the planning scheme includes an ablation scheme for the prostate middle lobe.

2. The method of surgical planning for treating prostatic hyperplasia using vapor ablation according to claim 1, wherein, 6.A surgical planning device for vapor ablation of prostate hyperplasia, the device is adapted to perform ablation by utilizing the principle of vapor convection in the intercellular space, comprising the following modules: an image and contour acquisition module for obtaining a preoperative image containing all prostate structures of a patient, and identifying key tissue contours in the preoperative image by using an image segmentation algorithm; a spherical region determination module for determining a plurality of spherical regions in the preoperative image, wherein each spherical region is determined based on the number of vapor holes released by a vapor needle and the vapor pressure control of the vapor needle, and each spherical region in each set of ablation schemes has a spherical center that is not in any other spherical region; a reference scheme determination module for calculating an ablation effect function for each set of ablation schemes, wherein the ablation effect function is determined based on the sum of the volumes of the spherical regions, the number of needle withdrawals, and a safety distance; and a planning scheme determination module for obtaining a real-time intraoperative ultrasound image containing all prostate structures of the patient, identifying key tissue contours in the real-time intraoperative ultrasound image by using an image segmentation algorithm, and determining a deformation degree coefficient based on the key tissue contours in the preoperative image and the key tissue contours in the real-time intraoperative ultrasound image; and further determining a planning scheme based on the deformation degree coefficient and the reference scheme.

3. The method of surgical planning for vapor ablation of prostatic hyperplasia according to claim 1 or 2, wherein, A memory, a processor, and a computer program stored on the memory and executable on the processor, wherein the computer program is executed by the processor to implement the method of any one of claims 1-5.

4. The method of surgical planning for the treatment of prostatic hyperplasia by vapor ablation according to claim 3, wherein, the ablation effect function f = a1 (V1 / Vtotal) - a2 Onum + a3 Lsafe, where a1, a2, a3 are coefficients representing weights, V1 is the sum of the volumes of the spherical regions in the evaluated set of ablation plans, Vtotal is the overall volume of the lateral and / or mid-lobes of the patient's prostate, Onum represents the number of needle passes, and Lsafe is the distance between the center of the safe bounding box and the straight line of the needle trajectory closest to the safe bounding box.

5. The method of surgical planning for treating prostatic hyperplasia by vapor ablation according to claim 1, wherein, 8.A computer readable medium having stored thereon a computer program, wherein the computer program is executed by a processor to implement the method of any one of claims 1-5. ​ ​ Reference scheme determination module: for fitting multiple sets of ablation schemes based on the key tissue contours identified in the preoperative image containing the entire prostate structure of the patient, with the position of the center of the prostatic urethral contour as the axis position, the position of the axial channel established by the insertion of the steam needle along the urethra as the needle exit point, the insertion position of the steam needle as the origin, and the ablation range of the steam needle as a spherical region; wherein, ​ ​ 7. An electronic device comprising: ​ ​

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