专题研究(Monographic Study)

3D打印技术在精准肝切除术前评估的应用

Published at: 2017年第26卷第7期

张朋飞 1 , 于松宁 2 , 雷鹏 2 , 卜阳 2 , 王新青 2 , 李海波 1 , 逄淑东 1 , 李海明 1
1 宁夏医科大学 研究生院,宁夏 银川 750004
2 宁夏医科大学总医院 肝胆外科,宁夏 银川 750004
通讯作者 松宁 于 Email: ysn_nxyc@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.07.004
基金:
宁夏科技攻关计划资助项目 2012/01-2017/12

摘要

目的:探讨医学3D打印技术在精准肝切除术前评估的应用价值。方法:回顾性分析2016年1月—2016年12月在宁夏医科大学总医院肝胆外科7例复杂性肝脏肿瘤患者临床资料。其中男5例,女2例,平均年龄55岁。患者术前经上腹部增强CT扫描,使用三维可视化软件(MI-3DVS)进行三维重建,导入3D打印机,打印出1:1肝脏物理模型,分析肝脏解剖、进行术前模拟,确定手术方案。 结果:全部患者的肝脏3D模型能清晰显示肝内脉管系统、肝脏及肿瘤组织解剖形态、肿瘤与肝内血管结构毗邻关系,计算出肝脏平均体积为(1 872.2±753.7)mL,肝脏肿瘤体积中位数为316.96 mL。根据3D打印结果,1例患者因肿瘤侵犯门静脉不适宜外科手术,建议行经肝动脉化疗栓塞术,其余6例均行精准肝切除,实际手术过程与术前手术规划完全符合(6/6),无围手术期期死亡。 结论:医学3D打印技术可应用于肝脏肿瘤的手术规划,在精准肝切除的术前评估有一定的指导意义。


Application of 3D printing technology in preoperative assessment of precise hepatectomy

Abstract

Objective: To investigate the value of medical 3D printing in preoperative assessment before precise hepatectomy. Methods: The clinical data of 7 patients with complex hepatic tumors from January 2016 to December 2016 in the Department of Hepatobiliary Surgery of General Hospital of Ningxia Medical University were retrospectively analyzed. Of the patients, 5 cases were male and 2 cases were female, with an average age of 55 years. All patients underwent upper-abdominal CT scan with three-dimensional reconstructions by three-dimensional visualization system (MI3DVS), which were imported into the 3D printer to create the exactly same size printed models of the livers. And then, the anatomical features of the livers were analyzed, preoperative simulations were performed and treatment plans were designed. Results: The 3D-printed liver models for all patients clearly showed the intrahepatic vasculature, anatomical morphology of hepatic and tumor tissues, and the adjoining relationship between the tumor and the intrahepatic vascular structures. The calculated average liver volume was (1 872.2±753.7) mL and median tumor volume was 316.96 mL. According to the results of 3D printing, one patient was not suitable for surgical resection due to portal vein tumor invasion, for whom transarterial chemoembolization was recommended, and all the remaining 6 patients underwent precise liver resection. All the actual surgical procedure was completely in accordance with the preoperative operation planning (6/6). No death occurred during the perioperative period. Conclusion: The medical 3D printing technology can be applied in surgical planning for liver tumors, and has certain guiding significance in preoperative evaluation of accurate liver resection.


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引用

引用本文: 朋飞 张, 松宁 于, 鹏 雷, 阳 卜, 新青 王, 海波 李, 淑东 逄, 海明 李. 3D打印技术在精准肝切除术前评估的应用[J]. 中国普通外科杂志, 2017, 26(7): 831-837.
Cite this article as: ZHANG Pengfei, YU Songning, LEI Peng, BO Yang, WANG Xinqing, LI Haibo, PANG Shudong, LI Haiming . Application of 3D printing technology in preoperative assessment of precise hepatectomy [J]. Chin J Gen Surg, 2017, 26(7): 831-837.