3D打印技术在儿童腹膜后神经母细胞瘤精准切除术中的价值  

An exploration into the value of 3D printing technology in the precise resection of pediatric retroperitoneal neuroblastoma

作　　者：鲍俊涛[1] 张书峰[1] 杨凯骅 孟庆磊[1] 秦璐莹[2] Bao Juntao;Zhang Shufeng;Yang Kaihua;Meng Qinglei;Qin Luying(Department of Pediatric Surgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China;School of Nursing and Healthy,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]河南省人民医院小儿外科,郑州450003 [2]郑州大学护理与健康学院,郑州450001

出　　处：《中华实用儿科临床杂志》2021年第21期1632-1635,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学教育研究课题(Wjlx2019088)。

摘　　要：目的探讨3D打印技术在儿童腹膜后神经母细胞瘤(NB)精准切除术中的应用价值。方法选取2017年3月至2019年12月河南省人民医院小儿外科收治的11例腹膜后NB患儿,患儿术前均行全腹部平扫+增强CT扫描,将原始数据导入mimics 20软件进行处理,使用多层编辑、阈值调节、区域增长、3D编辑等命令重建出肿瘤及周围重要血管,输出标准化的3D打印stl格式文件,通过3D打印机打印出肿瘤模型。根据3D重建结果进行精准手术规划,确定最佳手术方案。回顾性分析全部患儿资料,对患儿家长进行问卷调查,并对调查结果进行统计分析。结果11例患儿均在3D打印技术规划下完成手术,其中9例患儿实现肿瘤精准完整切除,2例患儿行姑息性切除,手术时间为140~750 min,平均210 min,出血量为100~1500 mL,平均240 mL。术后病理报告示NB 9例,节细胞NB 2例,无围术期死亡病例。术后并发症2例,包括1例严重腹泻合并乳糜漏,予肠外营养、生长抑素等对症治疗后缓解,1例左髂动脉吻合后左下肢负重困难,予康复理疗后好转。术后随访时间为1~30个月,2例出现原手术区域复发,其中1例化疗后接受再次手术、1例继续化疗中,2例姑息性切除患儿予化疗带瘤生存。应用3D模型病情沟通后患儿家长对疾病、手术方式、术后并发症等知晓率明显高于CT交代病情。结论3D打印技术能准确评估儿童腹膜后NB与周围重要血管的结构关系,有助于提高患儿家长对手术方式的认知程度,有利于筛选最佳手术方案,实现肿瘤精准切除。Objective To explore the application value of 3D printing technology in the precise resection of pediatric retroperitoneal neuroblastoma(NB).Methods Eleven patients with retroperitoneal NB admitted to the Department of Pediatric Surgery of Henan Provincial People′s Hospital from March 2017 to December 2019 were selected in this study,and all of them received preoperative plain and enhanced computed tomography(CT)scanning of whole abdomen.The original data were imported into the mimics 20 software for processing.The tumor and important peripheral blood vessels were reconstructed with such commands as multi-layer edition,threshold adjustment,regional growth and 3D edition to output the standardized 3D printing stl format file and print out the tumor model by 3D printer.Based on the 3D reconstruction results,the precise surgical planning was performed to determine the optimal operative scheme.The data of all cases were analyzed retrospectively.The parents of these children were investigated by questionnaire and the results were statistically analyzed.Results All 11 patients successfully underwent the operation under the planning of 3D printing technology.Nine of them had complete tumor resection and 2 cases had palliative resection.The operation time ranged from 140 min to 750 min,with an average of 210 min;the bleeding volume ranged from 100 mL to 1500 mL,with an average of 240 mL;the postoperative pathological reports revealed that 9 children had NB and 2 cases had ganglioneuroblastoma.There was no case of perioperative death.There were 2 cases of postoperative complications,including 1 case of severe diarrhea with chylous leakage,which was relieved after the treatment of parenteral nutrition and somatostatin,and 1 case of left lower extremity weight-bearing difficulty after left iliac artery anastomosis,which was improved after rehabilitation physical therapy.The follow-up time ranged from 1 month to 30 months.There were 2 cases recurred in the original operation area.One patient received reoperation after chem

关 键 词：3D打印技术 神经母细胞瘤 外科手术 

分 类 号：R735.4[医药卫生—肿瘤]