3D打印技术在颅内动静脉畸形血管内介入治疗中的初步应用

Preliminary application of 3D printing technology in endovascular interventional therapy of intracranial arteriovenous malformation

目的探讨3D打印技术在指导颅内动静脉畸形(AVM)血管内介入治疗中的临床应用价值。方法贯序交替选取2015年2月至5月广东省人民医院神经外科进行血管内介入治疗的AVM患者10例,其中5例为对照组,5例为进行3D打印模型试验组。对试验组5例AVM患者采用256层螺旋CT薄层增强扫描或3D-DSA旋转成像,提取检查结果的DICOM原始数据,应用薄层数据扫描获取5例AVM患者三维数据,通过Mimics 14.01软件进行数字化数据提取和重建,并按1∶1比例进行3D打印,获得实体模型。应用AVM实体模型指导与患者及其家属的术前谈话及手术方案设计,并与对照组结果进行对比。结果 3D打印模型试验组术前谈话时间(10.2±0.8)min较对照组术前谈话时间(15.0±1.3)min显著缩短,差异有统计学意义(P<0.01);试验组患者及其家属满意度评分显著高于对照组[(9.3±0.6)分比(8.1±0.3)分,P<0.01],试验组术中造影后至手术实施时间较对照组显著缩短[(5.7±0.4)min比(10.5±1.6)min,P<0.01]。无一例手术相关并发症。结论 3D打印模型可以帮助术者更加直观地了解畸形团空间构筑学特征,指导术者进行手术方案的制定,同时应用3D打印实体模型可提高与AVM患者术前谈话效率及患者满意度。

Objective To investigate the clinical application value of 3D printing technology in guiding endovascular interventional treatment of intracranial arteriovenous malformations（ AVM）. Methods Ten patients with AVM were alternately selected with off-sequence method,including 5 in a control group and 5in a 3D printing model test group From Feb. to May 2015 of Guangdong General Hospital. Five patients with AVM in the test group used 256 slice spiral CT thin layer enhanced scanning or 3D-DSA rotational imaging. The original DICOM data of the test results were extracted. The thin layer data scanning was used to obtain the three-dimensional data in 5 patients with AVM. The digitized data extraction and reconstruction were conducted by using Mimics14. 01 software,and were printed according to 1 ∶ 1 ratio and obtained a solid model. The solid model of AVM was used to guide the preoperative talk with the patients and their families and the surgical scheme design,and the results of the control group were compared. Results The preoperative talk time of the 3D printing model test group（ 10. 2 ± 0. 8 min） was reduced significantly compared with that of the control group（ 15. 0 ± 1. 3 min）. There was significant difference（ P 0. 01）.The satisfaction scores of patients and their families of the test group was significantly higher than those of the control group（ 9. 3 ± 0. 6 vs. 8. 1 ± 0. 3,P 0. 01）. From after intraoperative cholangiography to operation implementation time of the test group was significantly shorter than that of the control group（ 5. 7 ±0. 4 min vs. 1 0. 5 ± 1. 6 min; P〈0. 0 1）. None of the surgery-related complications were observed.Conclusion 3 D printing m odel can help the surgeons m ore intuitively understand the spatial structure characteristics of the nidi,guide the surgeons to make the operation plans,at the same time,the application of 3D printing solid model can improved the preoperative talk efficiency in patients with AVM and the satisfaction of patients.