3D打印技术在腹腔镜右半结肠癌根治术前评估中的应用价值

Application value of 3D printing technology in preoperative evaluation of laparoscopic radical resection of right colon cancer

目的探讨3D打印技术在腹腔镜右半结肠癌根治术前评估中的应用价值。方法采用前瞻性研究方法。选取2019年1—11月南京医科大学附属无锡第二医院收治的60例右半结肠癌患者的临床资料,采用随机数字表法将患者随机分为两组。60例患者术前均行平扫和增强X线计算机体层摄影术(CT)检查,患者术前应用3D打印技术将血管图像打印成1∶1完全仿真实体,设为3D打印组;患者术前仅行平扫和增强CT检查,设为对照组。60例患者均行右半结肠癌腹腔镜全结肠系膜切除术。观察指标:(1)3D打印组患者术前3D打印模型中Henle干的解剖类型及其与术中实际解剖类型的吻合情况。(2)两组患者术中及术后情况。正态分布的计量资料以±s表示,组间比较采用独立样本t检验。计数资料以绝对数或百分比表示,组间比较采用χ^2检验。结果筛选出符合研究条件的患者60例;男42例,女18例;年龄为(64±7)岁,年龄范围为44~78岁。60例患者中,3D打印组30例,对照组30例。(1)3D打印组患者术前3D打印模型中Henle干的解剖类型及其与术中实际解剖类型的吻合情况:30例3D打印组患者术前3D打印血管模型中,28例有Henle干,其中7例由胃网膜右静脉和胰十二指肠上前静脉构成2支型胃胰干;13例由胃网膜右静脉、中结肠静脉和(或)右结肠静脉构成2支型或3支型胃结肠干,包括4例由胃网膜右静脉和中结肠静脉构成2支型胃结肠干,6例由胃网膜右静脉和右结肠静脉构成2支型胃结肠干,3例由胃网膜右静脉、中结肠静脉和右结肠静脉成3支型胃结肠干;8例由胃网膜右静脉、胰十二指肠上前静脉、中结肠静脉和(或)右结肠静脉构成3支或4支型胃胰结肠干,包括4例由胃网膜右静脉、胰十二指肠上前静脉、中结肠静脉构成3支型胃胰结肠干,2例由胃网膜右静脉、胰十二指肠上前静脉、右结肠静脉构成3支型胃胰结肠干,2例由胃网膜右静脉、胰十二指肠上前静脉、中结肠静脉、右结肠静脉构成4支型胃胰结肠干。28例患者术前3D打印模型中Henle干的类型与术中Henle干实际类型吻合率为100%(28/28)。(2)两组患者术中及术后情况:3D打印组患者手术时间,术中出血量,淋巴结清扫数目,术后并发症(切口感染、肠梗阻、吻合口瘘、肺部感染),术后住院时间分别为(147±18)min,(79±29)mL,(19.1±2.8)枚,3例(1、1、0、1例),(9.0±2.5)d,对照组患者上述指标分别为(172±16)min,(118±17)mL,(15.6±2.6)枚,4例(1、1、1、1例),(9.1±2.6)d,两组患者手术时间、术中出血量、淋巴结清扫数目比较,差异均有统计学意义(t=-5.630,-18.400,3.318,P<0.05),两组患者术后并发症、术后住院时间比较,差异均无统计学意义(χ^2=0.875,t=0.103,P>0.05)。结论对于腹腔镜右半结肠癌根治术,应用3D打印技术可有效评估术前血管解剖走行,缩短手术时间,减少术中出血量,提高淋巴结清扫数目。临床试验注册:在中国临床试验注册中心注册,注册号:ChiCTR1800017161。

Objective To investigate the application value of 3D printing technology in preoperative evaluation of laparoscopic radical resection of right colon cancer.Methods The prospective study was conducted.The clinical data of 60 patients with right colon cancer who were admitted to the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University from January to November of 2019 were collected.Patients were randomly divided into two groups by random number method.All the 60 patients were examined by plain scan and enhanced X-ray computed tomography(CT)preoperatively.Patients with vascular images printed into a 1∶1 full simulation entity using the 3D printing technology were divided into 3D printing group,and patients who only completed the plain scan and enhanced CT examination were divided into control group.All the 60 patients underwent laparoscopic complete mesocolic excision for right colon cancer.Observation indicators:(1)anatomic courses of Henle trunk of the 3D printing group in the preoperative 3D printing models and their consistency with intraoperative anatomic courses;(2)intraoperative and postoperative situations of two groups.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the independent-sample t test.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.Results A total of 60 patients were selected for eligibility,including 42 males and 18 females,aged(64±7)years,with a range from 44 to 78 years.Of the 60 patients,30 were in the 3D printing group and 30 were in the control group.(1)Anatomic courses of Henle trunk of the 3D printing group in the preoperative 3D printing models and their consistency with intraoperative anatomic courses:Henle trunk was observed in 28 of the 30 patients in the 3D printing group.Of the 28 patients,7 had the gastropancreatic trunk of 2 branches formed with the right gastroepiploic vein and the superior anterior pancreaticoduodenal vein,13 had the gastrocolonic trunk of 2 or 3 branches formed with the right gastroepiploic vein,the middle colonic vein and(or)the right colonic vein(including 4 cases with gastrocolonic trunk of 2 branches formed with the right gastroepiploic vein and the middle colonic vein,6 cases with gastrocolonic trunk of 2 branches formed with the right gastroepiploic vein and the right colonic vein,3 cases with gastrocolonic trunk of 3 branches formed with the right gastroepiploic vein,the middle colonic vein and the right colonic vein),8 had the gastropancreaticocolonic trunk of 3 or 4 branches formed with the right gastroepiploic vein,the superior anterior pancreaticoduodenal vein,the right colonic vein and(or)the middle colonic vein(including 4 cases with gastropancreaticocolonic trunk of 3 branches formed with the right gastroepiploic vein,the superior anterior pancreaticoduodenal vein and the middle colonic vein,2 cases with gastropancreaticocolonic trunk of 3 branches formed with the right gastroepiploic vein,the superior anterior pancreaticoduodenal vein and the right colonic vein,2 cases with gastropancreaticocolonic trunk of 4 branches formed with the right gastroepiploic vein,the superior anterior pancreaticoduodenal vein,the right colonic vein and the middle colonic vein).The consistency of anatomic courses of Henle trunk of the 28 patients in the preoperative 3D printing models with intraoperative anatomic courses of bared Henle trunk was 100%(28/28).(2)Intraoperative and postoperative situations of two groups:the operation time,volume of intraoperative blood loss,the numbers of lymph node dissected,cases with postoperative complications(cases with incision infection,cases with intestinal obstruction,cases with anastomotic leakage,cases with pulmonary infection),postoperative duration of hospital of the 3D printing group were(147±18)minutes,(79±29)mL,19.1±2.8,3(1,1,0,1),(9.0±2.5)days,respectively.The above indicators of the control group were(172±16)minutes,(118±17)mL,15.6±2.6,4(1,1,1,1),(9.1±2.6)days,respectively.There were significant differences in the operation time,volume of intraoperative blood loss,the numbers of lymph node dissected between the two groups(t=-5.630,-18.400,3.318,P<0.05),and there was no significant difference in the cases with postoperative complications and postoperative duration of hospital between the two groups(χ^2=0.875,t=0.103,P>0.05).Conclusion For laparoscopic right colon cancer radical resection,3D printing technology can effectively evaluate the preoperative vascular anatomic courses,which can shorten operation time,reduce volume of intraoperative blood loss and improve the number of lymph node dissected.Trial Registration:This study was registrated at Chinese Clinical Trail Registry with the registration number of ChiCTR1800017161.