应用3D打印技术改进远离型右室双出口的外科治疗结果  

Application of 3D Printing to Improve Surgical Outcome of Double Outlet Right Ventricle with Non-committed Ventricular Septal Defect

作　　者：花中东 杨新令 刘凯飏 刘锐 张本清 高华伟 芮璐 胡盛寿 李守军 

机构地区：[1]中国医学科学院阜外医院,国家心血管病中心,北京阜外心血管病医院小儿心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2016年第6期532-536,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家“十二五”科技支撑计划项目(2011BAI11B19)~~

摘　　要：目的评估应用3D打印技术指导远离型右室双出口的手术决策、模拟和外科手术的效果。方法我院2012年1月至2013年12月,在3D打印技术指导下12例远离型右室双出口的患者经历治疗决策、手术模拟并最终完成了外科手术矫治,其中男9例、女3例,年龄(2.9±2.2)岁。3D打印技术指导策略包括:超声诊断确诊为远离型右室双出口,CT检查,基于CT的3D格式文件生成,3D打印心脏模型,外科手术模拟,外科手术。在模拟手术时,外科医生根据模型设计补片形状,室间隔缺损扩大方法,肌束切除方案等。8例患者行双心室矫治,4例行单心室矫治。双心室矫治的患者中6例行单纯心内隧道矫治,1例行心内隧道加动脉调转,1例行双根部调转手术。心室内隧道修补均施行了室间隔缺损扩大术。行单心室矫治的原因主要是非常小的限制型室间隔缺损和三尖瓣主要腱索或者乳头肌跨越主动脉瓣下流出道。结果全组患者手术中探查所见和术前3D打印模型相关性很好。无手术死亡,无重大并发症发生。1例患者术后有轻度的主动脉瓣下狭窄。没有随访期死亡和再次手术。参与手术的医生对于3D打印模型满意。结论 3D打印模型对于远离型右室双出口的手术决策能提供很好的帮助,并且通过提供外科手术模拟的术前评估从而减少手术并发症,改善手术结果。Objective To evaluate the efficacy of 3-dimensional printing model（3DPM） aiding decision making and surgery rehearsal for the treatment of double outlet right ventricle（DORV） with non-committed ventricular septal defect（NC-VSD）. Methods From January 1st,2012 through December 30 th,2014,12 patients with DORV and NC-VSD were operated with the aid of ＂3DPM guidance ＂ to do decision making and surgical technique rehearsal preoperatively. There were 9 males and 3 females at age of 2.9±2.2 years. The ＂ 3DPM guidance ＂ consisted of step by step procedures： computerized tomography（CT） scan for the patients,CT based 3DPM rendering,3DPM exploration,decision making,and surgery rehearsal. During surgery rehearsal,surgeons did patch designing,VSD enlargement planning,muscle bundle resection etc. Eight out of the twelve patients underwent biventricular repair,4 patients underwent single ventricle repair. Six of the eight biventricular repair patients had intra-ventricular baffle repair,1 patient had intra-ventricular baffle repair and arterial switch procedure,1 had modified Nikaidoh procedure. VSD enlargement was performed in all the patients in biventricular repair group. The reasons not to do a biventricular repair included very restrictive VSD,tricuspid attachments across the sub-aortic passway. Results The operation findings correlated well with the 3DPM in all the cases. There was no hospital death,no major complication. One patient had a mild sub-aortic stenosis and he was under close follow-up. There was no late death and reoperation. Surgeons involved were satisfied with the ＂3DPM guidance＂. Conclusions 3-D printing model is an excellent way to help decision making for DORV with NC-VSD and can provide surgery simulation which decrease complication rate and help achieve good outcomes.

关 键 词：右室双出口 双心室矫治 远离型室间隔缺损 

分 类 号：R726.5[医药卫生—儿科]