3D打印技术在胃肠道恶性肿瘤术前评估中的作用分析

Role of 3D printing technology in preoperative evaluation of malignant gastrointestinal tumors

目的探讨3D打印技术在存在重要血管侵犯的胃肠道恶性肿瘤术前评估中的作用。方法选取医院2017年1月~2019年6月期间收治的80例侵犯重要血管的晚期胃肠道恶性肿瘤患者,分为3D打印模型组(A组,n=30,将患者病变部位重建为CT三维图像,并用3D打印技术制造病变出模型,观察肿瘤与邻近腹部大血管间的关系以行术前评估、制定手术方案)和普通影像学检查组(B组,n=50,患者仅进行三维重建,并接受传统手术方式治疗)。两组患者术前均进行新辅助化疗。术后对两组患者的手术时间、术中并发症和预后进行评估。结果A组手术时间较B组短,但差异无统计学意义(P>0.05)。A组术中出血量比B组少、住院时间短于B组(P<0.05)。A组术后癌胚抗原(CEA)及癌抗原19-9(CA-199)水平与B组相比较低(P<0.05)。术后3个月世界卫生组织生存质量测定简表(WHOQOL-BREFl)结果显示,A、B两组术后比较A组更具优势(P<0.05)。自制量表评分,血管系统细节呈现平均(7.9±0.6)分,病变组织位置与周围组织关系呈现平均(7.9±1.2)分,逼真度平均(7.7±0.2)分。胃癌患者术后与实际肿瘤直径对比,三维模型的误差为(2.6±0.1)mm。直肠癌患者术后与实际肿瘤直径对比,三维模型的误差为(2.4±0.3)mm。结论应用3D打印技术能够对有重要血管侵犯的胃肠道恶性肿瘤经术前进行精准评估,可提前预测术中可能出现的风险,并改善患者临床结局,因此3D打印技术在此类手术中应用前景广阔。

Objective To explore the role of 3 D printing technology in preoperative evaluation of malignant gastrointestinal tumors invading important blood vessels.Methods A total of 80 patients with advanced malignant gastrointestinal tumors invading important blood vessels who were admitted to our hospital from January 2017 to June 2019 were selected and divided into group A(n=30,3 D printing model group,the lesion of the patient was reconstructed into a 3 D CT image,and the lesion model was created using3 D printing technology;the relationship between the tumor and the large vessels in the adjacent abdomen was observed for preoperative evaluation and operation plan)and group B(n=50,routine imaging examination group;only 3 D reconstruction and traditional surgical treatment were conducted for the patients).Before the operation,both groups received neoadjuvant chemotherapy.After the operation,the operative time,intraoperative complications,and prognosis between the two groups were evaluated.Results The operative time in group A was shorter than that in group B,the difference was not statistically significant(P>0.05).The intraoperative blood loss in group A was less than that in group B,the difference was statistically significant(P<0.05).The length of stay in group A was shorter than that in group B,the difference was statistically significant(P<0.05).After the operation,the levels of carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA-199)in group A were lower than those in group B,the differences were statistically significant(both P<0.05).The results of the World Health Organization Quality of Life-BREF(WHOQOL-BREF)performed 3 months after the operation showed that group A was superior to group B after the operation(P<0.05).The scores of a self-developed scale were as follows:the vascular system had an average score of 7.9±0.6,the relationship between the lesion site and surrounding tissues had an average score of 7.9±1.2,the fidelity had an average score of 7.7±0.2.Compared with the diameter of the actual tumor of patients with gastric cancer after the operation,the error of the 3 D model was(2.6±0.1)mm.Compared with the diameter of the actual tumor of patients with rectal cancer after the operation,the error of the 3 D model was(2.4±0.3)mm.Conclusion The application of 3 D printing technology allows for accurate preoperative evaluation of malignant gastrointestinal tumors invading important blood vessels,which can predict the possible intraoperative risks and improve the clinical outcome of patients.Therefore,3 D printing technology is promising in applying to such operations.