3D打印导板在颅内肿瘤立体定向活检中的应用  

Application of 3D printing guide plate technique in stereotactic tissue biopsy of intracranial tumor

作　　者：李鹏 佘春华 张振 孙增峰 伊凯凯 张瑞平 Peng Li;Chunhua She;Zhen Zhang;Zengfeng Sun;Kaikai Yi;Ruiping Zhang(Department of Neuro-Oncology and Neurosurgery,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention&Therapy,Tianjin's Clinical Research Center for Cancer,Tianjin 300060,China;Department of Radiation Oncology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention&Therapy,Tianjin's Clinical Research Center for Cancer,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院脑系肿瘤科,国家恶性肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津市300060 [2]天津医科大学肿瘤医院放射治疗科,国家恶性肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津市300060

出　　处：《中国肿瘤临床》2023年第12期626-630,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨3D打印导板引导下脑肿瘤立体定向活检技术的准确性、有效性和临床应用价值。方法:回顾性分析2022年1月至2022年12月于天津医科大学肿瘤医院采用3D打印导板引导下立体定向活检脑肿瘤患者12例的临床资料。病灶最大层面直径28.7(15~63)mm。术前行螺旋薄层CT平扫、强化、血管灌注成像扫描(层厚1.25 mm)。DICOM格式CT图像传输至Minics 19.0图像处理系统,勾画穿刺靶点、进针通道,3D打印穿刺导板。手术麻醉方式为10例全麻,2例局麻。术中依鼻根、眉弓标志放置导板,依规划的穿刺轨迹多点取材,获得病理组织送检。术后复查头部CT。结果:术后CT影像提示全部准确到达规划的靶点。10例全麻患者评价耗时75~80 min,2例局麻患者分别耗时约40 min和35 min。12例患者中1例术中急性出血,改变头位充分引流后未形成血肿,6例微量血肿形成(出血量<1 mL),8例轻微水肿(反应带<3 mm),3例轻微头疼。术后病理显示胶质瘤5例,转移瘤3例,淋巴瘤3例,脱髓鞘1例。结论:3D打印导板引导下的立体定向活检技术不仅准确、安全,而且操作简便、节省时间、减少患者痛苦、体位灵活、成本低廉。Objective:To explore the validity,effectiveness,and clinical value of 3D printing guide plate technique-mediated brain tumor stereotactic tissue biopsy.Methods:Twelve patients who underwent stereotactic biopsy using a 3D printing guide plate between January 2022 and December 2022 were retrospectively analyzed at Tianjin Medical University Cancer Institute&Hospital.The maximum dimensional diameter was 15-63 mm(mean,28.7 mm).Before the operation,all patients underwent head plain and contrast-enhanced computed tomography(CT)and CT perfusion imaging(layer thickness=1.25 mm).CT images in the DICOM format were transferred and analyzed using the Mimics 19.0 software.The 3D images were reconstructed,the target delineation and puncture channel were outlined,and the 3D guide plates were finally printed.The surgical anesthesia was general in 10 patients and local in two patients.The 3D guide plates were placed according to the nasal root and brow arch landmarks,and pathological tissues were obtained and sent for examination at multiple points according to the planned puncture trajectory.All patients underwent head CT after the operation.Results:Postoperative CT imaging suggested that the puncture reached the planned target site accurately in all patients.The operation time was approximately 75-80 min for the 10 patients with general anesthesia and 40 min and 35 min for the two patients with local anesthesia,respectively.One patient had acute intraoperative bleeding,but no hematoma was formed after adequate drainage by changing the head position,six had micro-hematoma formation(<1 mL),eight had a mild edema reaction zone(<3 mm),and three had a mild headache.The postoperative pathology was glioma in five patients,metastasis in three(lung cancer in two and breast cancer in one),lymphoma in three,and demyelination in one.Conclusions:The 3D printing guide plate-mediated stereotactic tissue biopsy technique is not only accurate and safe,but also has the advantages of a simple operation procedure,saving time,decreasing patient dis

关 键 词：3D打印 立体定向 活检 脑肿瘤 

分 类 号：R739.41[医药卫生—肿瘤]