3D打印技术在保留肾单位手术中的应用研究(附19例报告)  

Application of 3D-printing technology in nephron-sparing surgery(Report of 19 cases)

作　　者：李明峰 谢宇[1] 刘侃 叶明佶 刘纯 何庆[2] 刘志中[1] 宋波[2] 韩惟青[1] 

机构地区：[1]湖南省肿瘤医院泌尿外科,长沙410006 [2]湖南省肿瘤医院放射诊断科

出　　处：《临床泌尿外科杂志》2017年第12期938-941,共4页Journal of Clinical Urology

基　　金：湖南省卫生计生委科研计划课题项目(编号A2016002)

摘　　要：目的:探讨3D打印技术在肾肿瘤保留肾单位手术(NSS)中的临床应用价值。方法:选取2015年9月~2016年5月收治的19例肾肿瘤患者。提取患者的CT平扫加增强扫描数据,使用三维影像学软件进行处理,进行3D打印技术制作患者肾脏模型。将模型用于术前的医患沟通及手术规划,以及在手术中使用模型实时指导手术操作。术后请手术医生填写模型评估调查问卷,以评估该模型的真实性及实用性。结合3D模型进行术前谈话,请患者及家属填写3D模型调查问卷并评分。收集术中肾动脉阻断时间、出血量、切缘阳性率,以评估手术效果。结果:成功打印出19例患者的肾脏模型,该模型清晰的显示了患者的肿瘤大小、位置、浸润深度及与肾血管、集合系统的关系,肿瘤模型最大直径与患者术前CT影像肿瘤最大直径平均误差为(0.37±0.28)cm。根据3D模型制定手术方案:肾动脉全阻断14例,分支阻断4例,肾动静脉全阻断1例。手术医师对3D模型的总体评价得分为(9±0)分,患者及家属对使用3D模型的术前谈话的总体满意度得分为(8.5±0.8)分。手术肾动脉阻断时间(27±4)min,术中出血量(98±52)ml,术后病理切缘均为阴性。结论:3D打印模型能够精确显示肿瘤大小、位置、浸润深度及与肾血管、集合系统的关系,帮助医生进行术前手术方案指导和术中实时指导,同时可以作为NSS术前医患沟通的有效工具。Objective：To explore the clinical value of 3 D-printing technology in nephron-sparing surgery（NSS）.Method：Nineteen patients of renal tumor in Hunan Cancer Hospital from September 2015 to May 2016 were selected in the present study.The preoperative CT scan of renal was processed by three dimensional radiological software,and the final models were made by 3 D-printing technology.The models were applied to the preoperative patients communication and operation planning,and could be used to guide the operation in real time.After the operation,operators were asked to fill the questionnaire to evaluate the authenticity and efficacy of the model.By using the models in consultation before operation,the patients and their family members were asked to fill questionnaires and the efficacy of the models in doctor-patient communication was also evaluated.The warm ischemia time,intraoperative blood loss and positive rate of tumor resection margin were recorded to evaluate the efficacy of surgery.Result：The 19 3 D-printed models of renal tumor were set up well and all the operations were successful.The 3 D models clearly exhibited the size and position of the renal tumor and the relationship between tumor and renal artery,renal vein and collecting system.The average deviation of maximum diameter between the3 D model and the preoperative CT scan was（0.37±0.28）cm.According to the 3 D model,different surgical methods were selected（14 cases of renal artery clamping,4 cases of renal artery branch clamping and 1 case of renal artery and vein clamping）.The average evaluation score of the models given by operators was（9.0±0）and the average score of the doctor-patient conversation before operation given by the patients or their family members was（8.5±0.8）.The warm ischemia time was（27±4）min,and the intraoperative blood loss was（98±52）ml.Conclusion：The 3 D model could clearly exhibit the size and position of the renal tumor and the relationship between tumor and renal artery,renal vein and collecti

关 键 词：3D打印 肾部分切除术 腹腔镜 术前规划 医患沟通 

分 类 号：R737.11[医药卫生—肿瘤]