3D打印技术在复杂先天性心脏病外科诊疗中的应用

Application of three-dimensional printing technique in surgical treatment of congenital heart disease

目的评估3D打印技术在先天性复杂心脏畸形中的应用价值。方法纳入2例复杂先天性心脏病患者,利用术前心脏CT数据,采用WJP白墨填充技术(White-Jet-Process)-高精度彩色多材料数字化增材制造技术,打印心脏畸形的1∶1实物模型,用于术前规划,医生培训和术前模拟。结果成功打印出1∶1大小比例的具有畸形结构解剖细节的镂空全彩3D心脏模型,并在纵轴中点部位横断,可以打开模型观察心脏内部结构,但病例1的模型缺失了房间隔缺损的病变。参考该模型,手术组进行术前讨论、模拟操作,最终确定手术方案,并成功实施了预定手术方案。患者术后均恢复顺利,1个月后随访无并发症及死亡。结论尽管当前3D打印技术在复杂先天性心脏病模型打印中仍有缺陷之处,但术前使用心脏3D模型制定手术方案,进行模拟操作,可提高手术小组对手术方案及操作步骤的理解程度,提高术中配合默契度,改善手术效果,且未来可预见打印心脏模型能够完成从单纯解剖形态向功能测试的进步,在复杂先天性心脏病外科诊疗领域值得进一步推广。

Objective To evaluate the application of three-dimensional printing technique in surgical treatments on complex congenital heart diseases. Methods Two patients were enrolled with complex congenital heart diseases. The computerized tomography data were used to build the 3 D architecture of cardiac anomalies. The White-Jet-Process technique was used to print the models with 1∶1 ratio in size. The models were used to make the treatment strategy making, young surgeon training and operation simulation. Results The full color and hollowed-out cardiac models with 1∶1 ration in size were printed successfully. They were transected at the middle point of vertical axis, which was conveniently to explore the intracardiac anomalies. However, for patient 1, the model lost the atrial septal defect.Taking the two models as references, operation group held preoperative consultation, operation simulation, and finally,the operation plans were determined for the two patients. Both the two operation were carried out smoothly.Conclusion Although the limitations of 3 D printing still exist in the application for congenital heart diseases, making the p reoperative plan and operation simulation via 3 D cardiac model could enhance the understanding of following operation and procedure details, which could improve the tacit cooperation among operation group members.Furthermore, operation results also could be improved potentially. Therefore, the cardiac 3 D printing should be popularized in clinic in the future.