CT血管造影血管定位联合精细化三维打印指导复杂口腔癌切除与修复的效果  

Evaluation of CT angiography vascular localization combined with refined three-dimensional printing in guiding the resection and reconstruction of complex oral cancer

作　　者：高水超 田皞[1] 喻建军[1] 谌星[1] 左良[1] 蔡旭 石磊[2] 宋波[3] 周晓[1] Gao Shuichao;Tian Hao;Yu Jianjun;Chen Xing;Zuo Liang;Cai Xu;Shi Lei;Song Bo;Zhou Xiao(The Second Department of Head and Neck Surgery,Hunan Cancer Hospital,Changsha 410000,China;Department of Hepatobiliary Surgery,Hunan Cancer Hospital,Changsha 410000,China;Department of Diagnostic Radiology,Hunan Cancer Hospital,Changsha 410000,China)

机构地区：[1]湖南省肿瘤医院头颈外二科,长沙410000 [2]湖南省肿瘤医院肝胆外科,长沙410000 [3]湖南省肿瘤医院放射诊断科,长沙410000

出　　处：《中华肿瘤杂志》2019年第7期496-500,共5页Chinese Journal of Oncology

基　　金：湖南省自然科学基金(2018JJ2244);湖南省科技厅项目(2013SK3206);湖南省肿瘤整形外科临床医学技术研究中心(2013TP4087).

摘　　要：目的探讨CT血管造影(CTA)血管定位联合精细化三维(3D)打印技术在复杂口腔癌切除及修复中的应用价值。方法回顾性分析2013年12月至2017年7月就诊于湖南省肿瘤医院的30例复杂口腔癌患者的临床资料,分别采用CTA+3D辅助手术(15例)和传统手术(15例)治疗。在CTA+3D辅助手术组中,应用CT和磁共振成像数据,结合CTA重建后,3D打印精细化实体模型及手术导板,结合术前、术中虚拟手术系统和术者的经验进行术前评估和手术。在传统手术组中,术者根据影像学结果,凭临床经验进行术前评估及手术。比较CTA+3D辅助手术组和传统手术组患者的手术时间、术中出血量、住院时间和局部复发率等。结果CTA+3D辅助手术组中,1例患者通过3D模型直观了解病灶后,放弃手术治疗,其余14例患者手术均按计划顺利实施手术;传统手术组中,15例患者全部接受手术,其中3例因术前评估不足术中临时被动更改手术方案。CTA+3D辅助手术组和传统手术组患者的术中出血量分别为(320.1±27.2)ml和(430.2±30.3)ml,手术时间分别为(440.3±19.2)min和(552.2±23.3)min,住院时间分别为(20.4±3.2)d和(25.1±3.7)d,差异均有统计学意义(均P<0.05)。CTA+3D辅助手术组患者的1、3年局部复发率分别为9.1%和28.6%,传统手术组分别为14.3%和50.4%,差异有统计学意义(P<0.05)。结论对于张口困难或术后复发的复杂口腔癌患者,与仅凭影像学资料和术者临床经验进行手术的患者比较,应用CTA血管定位联合精细化3D打印技术进行手术的患者手术效果和术后恢复情况较好。Objective To evaluate the effect of vascular localization using computerized tomography angiography(CTA)combined with refined three dimensional(3D)printing in guiding the resection and reconstruction of complex oral cancer.Methods From December 2013 to July 2017,the clinical data of 30 patients with complex oral cancer enrolled in the Hunan Cancer Hospital were retrospectively analyzed.15 patients received CTA+3D assisted surgery,while the other 15 patients underwent traditional surgery.In CTA+3D assisted surgery group,CT and Magnetic Resonance Imaging(MRI)data were combined with CTA to print refined solid 3D model and surgical guide plate.The preoperative and intraoperative virtual surgical system and the operative experience were combined for preoperative evaluation and surgery.In traditional surgery group,preoperative evaluation and surgery were performed according to imaging data and surgeons′clinical experience.Operative time,intraoperative blood loss,hospital stay and local recurrence rate were compared between the two groups.Results In CTA+3D assisted surgery group,one patient gave up surgical treatment after intuitively watching the lesion through the 3D model,and the remaining 14 patients underwent surgery as planned.All the 15 patients in traditional surgery group received surgery.But the preoperative plans of three patients were temporarily and passively modified due to insufficient preoperative evaluation.The average intraoperative blood loss was(320.1±27.2)ml in CTA+3D assisted surgery group and(430.2±30.3)ml in traditional surgery group.Mean operation time was(440.3±19.2)min and(552.2±23.3)min,respectively.Mean hospitalization time was(20.4±3.2)d and(25.1±3.7)d,respectively.The differences were all statistically significant(all P<0.05).1 year and 3 years local recurrence rates were 9.1%and 28.6%in CTA+3D assisted surgery group,as well as 14.3%and 50.4%in traditional surgery group with statistical significance(P<0.05).Conclusion For complex oral cancer patients with difficulty in opening the

关 键 词：口腔颌面肿瘤 CT血管造影 三维打印 手术导板 修复 

分 类 号：R739.8[医药卫生—肿瘤] R730.44[医药卫生—临床医学]