3D打印技术辅助介入治疗先天性主动脉缩窄8例  

3D printing assisted interventional therapy for congenital coarctation of aorta: 8 cases of analysis on clinical efficacy

作　　者：徐臣年 樊镇阁 刘洋 赵宏亮 丁鹏 金屏 李兰兰 马燕燕 杨剑 Xu Chennian;Fan Zhenge;Liu Yang;Zhao Hongliang;Ding Peng;Jin Ping;Li Lanlan;Ma Yanyan;Yang Jian(Department of Cardiovascular Surgery,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China;Department of Rodiology,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院心血管外科,西安710032 [2]空军军医大学西京医院放射科,西安710032

出　　处：《中华胸心血管外科杂志》2021年第7期399-403,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81774415,81600240);国家重点研发计划(2016YFC1101000);军队后勤重大课题(ALJ17J001);西京医院学科助推计划(XJZT18MJ69)。

摘　　要：目的:探讨应用3D打印主动脉模型进行术前评估及手术模拟,辅助介入治疗先天性主动脉缩窄(coarctation of the aorta,CoA)的可行性与有效性。方法:回顾性分析2017年12月至2019年1月于空军军医大学西京医院接受经皮球囊扩张式覆膜支架置入术的8例先天性主动脉缩窄患者。其中男7例,女1例,年龄(32.00±14.93)岁。术前采集患者心脏及主动脉CT数据,利用Mimics软件重建,结合3D打印技术制作患者主动脉病变部位模型,术前进行手术模拟,确定最佳手术方案及对可能发生情况进行预估,收集整理患者住院和随访期间的相关临床资料。结果:8例患者均成功经股动脉途经于CoA处置入覆膜支架1枚,术后测量,CoA处最窄径由术前(3.70±2.94)mm增至术后即刻(18.01±1.51)mm(P<0.05),跨缩窄收缩压差由术前(83.75±25.44)mmHg(1 mmHg=0.133 kPa)下降至术后(14.63±8.09)mmHg(P<0.05)。右上肢收缩压由术前(204.13±22.31)mmHg下降至术后(145.63±32.08)mmHg(P<0.05);下肢动脉收缩压术前、后差异无统计学意义。患者术后住院及随访期间,未见明显相应心血管并发症。结论:经皮球囊扩张式覆膜支架置入治疗青少年及成人CoA短期疗效明显,3D打印模型个体化复制患者弓缩窄部位解剖模型,对于辅助介入治疗主动脉弓缩窄术前评估与手术预案制定具有可行性与有效性。Objective To explore the feasibility and effectiveness of 3D printing aortic model for preoperative evaluation and surgical simulation,and to assist interventional treatment of coarctation of the aorta(CoA).Methods From December 2017 to January 2019,8 patients with congenital coarctation of the aorta who underwent percutaneous balloon dilatation and covered stent placement in Xijing Hospital of Air Force Military Medical University were analyzed retrospectively.Among them,7 cases were male and 1 case was female.The age was(32.00±14.93)years old.Before operation,CT data of patients'heart and aorta were collected,reconstructed with Mimics software,and 3D printing technology was used to make the model of patients'aortic lesions.Before operation,the operation simulation was carried out to determine the best operation scheme and estimate the possible situation,and the relevant clinical data of patients during hospitalization and follow-up were collected.Results One stent graft was successfully implanted into CoA through femoral artery in all 8 patients.The mean diameter of CoA increased from(3.70±2.94)mm before operation to(18.01±1.51)mm immediately after operation(P<0.05),and the mean systolic pressure difference decreased from(83.75±25.44)mmHg before operation to(14.63±8.09)mmHg after operation(P<0.05).The mean systolic blood pressure of the right upper extremity decreased from(204.13±22.31)mmHg before operation to(145.63±32.08)mmHg after operation(P<0.05),and there was no significant difference between the two groups.During the period of hospitalization and follow-up,no corresponding cardiovascular complications were found.Conclusion The short-term effect of percutaneous balloon dilatation covered stent implantation on CoA in adolescents and adults is obvious.3D printing model can reproduce the anatomical model of CoA site of patients individually,which is feasible and effective for the preoperative evaluation of CoA and the preparation of operation plan.

关 键 词：3D打印 主动脉缩窄 覆膜支架 介入治疗 

分 类 号：R543.1[医药卫生—心血管疾病]