3D打印技术在儿童腹膜后肿瘤手术规划中的应用

Application of 3-dimensional printing in surgical planning for pediatric retroperitoneal tumor

目的探讨3D打印技术在儿童腹膜后肿瘤手术规划及医患沟通中的应用价值。方法选取2015年2月至2016年9月收治的11例腹膜后肿瘤患儿的全腹部CT平扫+增强DICOM格式的原始数据,使用Mimics软件对CT图像进行阈值选取、区域增长、模具处理、多层编辑修饰等建模过程,最终获得完整的肿瘤3D模型,通过3D打印机打印出患儿的肿瘤模型。术前将得到的肿瘤3D模型通过计算机进行分析并与患儿家属谈话。采用3D模型使用情况调查表分别对患儿家属及手术助手进行问卷调查。结果本研究成功建立11例腹膜后肿瘤的3D模型,肿瘤与周围临近脏器、血管的情况显示清晰。其中8例成功施行肿瘤切除术,3例患儿家属要求转院治疗。患儿家属较谈话前对病情掌握程度明显提高(P<0.05),手术助手满意度调查评分(9.1±1.5)分。结论通过3D打印出的肿瘤模型可清晰显示儿童腹膜后肿瘤复杂的解剖关系,有助于术前规划出合理的手术方式,并可提高患儿家属对于手术方式的认知,有利于增进家属对于治疗的配合。

Objective To explore the application of 3-dimensional（ 3 D） printing in surgical planning for pediatric retroperitoneal tumor（ RT） and communication between doctor and patients. Methods From February 2015 to September 2016,11 RT children received enhanced computed tomography（ CT） scanning of whole abdomen. The imaging data were saved in DICOM format. 3 D model was reconstructed by MIMICS software by threshold,region growing morphology operation and multi-layer edition. Meanwhile,the data of model were sent to 3 D printer. Finally the model was used for surgical planning and doctor-patient communications.Questionnaire was distributed at the same time. Results Clinical 3 D models were successfully established by3 D printing. Based upon these models,tumors,adjacent organs and vessels were distinctly delineated. With the assistance of printing models,8 cases underwent tumorectomy successfully and another 3 cases opted for hospital transfer. On average,the questionnaire results of patient satisfaction were higher than before（ P〈0. 05）. And the satisfaction results of surgeon assistants were 9. 1 ± 1. 5 points. Conclusion Complex relationship between tumor and adjacent tissue may be distinctly delineated by 3 D printing models. Moreover,this technique allows for rational individualized surgical planning,improved understanding of disease and better therapeutic compliance.