医学影像导航技术在微创手术中具有重要的作用，可以帮助医生实时确定手术器械与患者解剖结构之间的空间关系，保证微创治疗的安全性与准确性。基于立体全像技术的增强现实导航可以提供真三维增强现实手术导航场景，能够解决二维导航界面缺乏三维信息且医生手眼不协调的问题。然而立体全像增强现实导航还面临体内器械远端难以高精度定位和医学图像-患者难以高精度注册等主要问题，不利于精准微创治疗的开展。本文围绕基于立体全像增强现实导航的微创治疗关键科学问题开展研究，具体工作如下：（1）针对微创治疗中的体内器械远端难以高精度定位的问题，本研究提出了可以同时跟踪刚性手术器械和体内易受力形变手术器械的光学和电磁混合跟踪方法。采用定点旋转标定方法和基于参考标记物的标定方法以确定刚性手术器械的方向和尖端位置，采用基于几何关系计算的方法标定如髓内钉等易受力形变手术器械的远端。为实现手术器械与其裸眼立体图像的原位叠加，采用光学标记物标定空间透视融合装置，满足增强现实引导的精准微创治疗的需要。（2）针对微创治疗中的医学图像-患者难以高精度注册的问题，本研究提出了利用术中超声图像获取体内刚性解剖点注册患者的方法，克服软组织形变影响，并以椎弓根钉植入手术为例进行了实验验证。本研究还针对种植牙手术提出了利用三维点云配准技术或利用包含人造标记点的注册跟踪装置执行术前图像-患者注册的方法，克服解剖特征点取点精度难以满足要求的问题，减少注册过程对患者造成的不适，并获得了高精度的注册结果。（3）针对立体全像增强现实手术导航在微创治疗中的应用，开发了高精度立体全像增强现实手术导航系统，并有针对性的执行多个临床应用评估，包括基于光磁混合跟踪和增强现实引导的髓内钉远端锁定；基于超声辅助注册和增强现实引导的椎弓根钉微创植入；基于三维点云或注册跟踪装置注册的增强现实导航种植牙手术。此外，本课题以开腹肝门部胆管癌根治性切除术和脑干肿瘤切除手术为例介绍了立体全像增强现实手术导航系统在肿瘤切除手术中的临床应用。综上所述，本论文通过系列实验验证了手术器械高精度定位、医学图像-患者高精度注册和增强现实引导的精准微创治疗等关键理论和方法的可行性，展望了立体全像增强现实手术导航系统在微创治疗中的应用前景。

Medical image-guided navigation plays an important role in minimally invasive surgery, which can help surgeons to determine the real-time spatial relationship between the surgical instruments and the anatomical structure of the patients, so as to ensure the safety and accuracy of minimally invasive treatment. The augmented reality (AR) navigation using integral videography (IV) technology can provide a real 3D AR navigation scene, and can solve the following problems: the lack of 3D information on the 2D screen and the shortage of hand-eye coordination. However, the IV-based AR navigation system is also faced with the inaccurate positioning of the distal surgical instrument and inaccurate image-patient registration, which are not conducive to minimally invasive treatment. This research focuses on AR-guided minimally invasive treatment based on IV technology. We mainly carry out the following research works:(1) An optical and electromagnetic hybrid tracking method, which can track both rigid and non-rigid instruments at the same time, is proposed to solve that the distal parts of the surgical instruments in the human body are difficult to locate accurately. A pivot calibration method and a reference marker-based calibration method are used to determine the directions and tip locations of the rigid instruments, while the distal hole of the intramedullary nail is calibrated by its geometric relationship. In order to realize the superposition of the surgical instruments and their 3D images, the IV overlay device is calibrated using an optical marker, meeting the needs of AR-guided minimally invasive treatment.(2) Since that medical image-patient registration is hard to be achieved, a registration method by using the intraoperative ultrasound images to obtain the rigid anatomical points in the human body is proposed, overcoming the influence of soft tissue deformation. The registration method is evaluated through AR-guided pedicle screw implant. The medical image-patient registration methods by using 3D point cloud matching technology and the registration device including several artificial markers are also proposed, overcoming the problem that the fetching accuracy of the anatomical feature points is hard to meet the clinical requirement. The two methods reduce the patient’s discomfort caused by the registration process and take the teeth as an example, a high registration accuracy has been obtained.(3) For the clinical applications of AR-guided minimally invasive treatment using IV technology, we have developed an AR navigation system and have performed several clinical evaluations, as follows: hybrid tracking and AR navigation for distal locking of intramedullary nail; ultrasound-assisted registration and AR navigation for pedicle screw implant; 3D point cloud registration or the registration device-based registration and AR navigation for dental implant surgery. In addition, the applications of the AR navigation system in tumor resection surgery are introduced with AR-guided cholangiocarcinoma resection and AR-guided resection of brainstem glioma. In conclusion, the feasibility of the key theories and methods are evaluated, including accurate positioning of the distal surgical instrument, accurate image-patient registration and AR-guided minimally invasive treatment. The application prospects of IV AR navigation system in minimally invasive surgery is demonstrated.