3D打印技术在Stanford B型主动脉夹层腔内隔绝治疗术前评估中的作用

Role of 3D printing technology in preoperative evaluation of Stanford B aortic dissection endovascular isolation therapy

目的探讨应用主动脉3D打印模型进行术前体外模拟辅助腔内隔绝治疗Stanford B型主动脉夹层(TBAD)的可行性及有效性。方法回顾性分析介入腔内隔绝治疗的20例TBAD患者临床与影像学资料,其中男11例,女9例,年龄(48±12)岁。利用患者主动脉CTA数据,导入Mimics软件进行计算机重建,结合3D打印技术制作TBAD患者病变主动脉模型,并于术前进行手术模拟,确定最佳手术方案,探讨预防并发症方法,并统计分析患者住院和随访期间的CT等资料,分析比较术前、术后1月、3月、6月及12月主动脉近端破口平面(L1)、支架末端平面(L2)、腹腔干动脉平面(L3)的真、假腔内径实测值及假腔血栓化情况。结果20例TBAD患者均成功经股动脉于夹层近端破口处植入覆膜支架1枚,术后12个月复查CTA,测量L1[(19.3±2.3)mm vs.(40.6±4.8)mm,P<0.05]、L2[(18.3±2.2)mm vs.(30.32±4.59)mm,P<0.05]、L3[(11.3±1.2)mm vs.(15.2±1.6)mm,P<0.05]平面真腔实测直径较术前增加,在L1[(21.5±3.3)mm vs.(4.9±2.6)mm,P<0.05]、L2[(21.1±3.0)mm vs.(5.1±2.5)mm,P<0.05]、L3[(18.5±1.3)mm vs.(15.9±1.6)mm,P<0.05]平面假腔实测直径较术前减小,支架植入后,假腔逐渐开始血栓化,术后随访期间,所有患者未出现严重并发症。结论经导管腔内隔绝治疗成人TBAD短中期疗效明显,3D打印技术对于TBAD患者术前辅助评估作用具备可行性与有效性。

AIM To investigate the feasibility and effectiveness of preoperative in vitro simulation assisted endovascular isolation in the treatment of Stanford type B aortic dissection(TBAD).METHODS The clinical and imaging data of 20 patients with tbad who received interventional endovascular isolation therapy were analyzed retrospectively,including 11 males and 9 females,aged(48±12)years.The CTA data of patients’aorta were imported into Mimics software for computer reconstruction,and the pathological aortic model of TBAD patients was made with 3 D printing technology.The operation simulation was carried out before operation to determine the best operation scheme and the method of preventing complications.The CT data during hospitalization and follow-up were statistically analyzed.The preoperative data and the data collected 1 month,3 months,6 months and12 months after intervention were analyzed and compared.The measured true and false lumen diameters and false lumen thrombosis of proximal aortic break plane(L1),stent end plane(L2)and celiac trunk artery plane(L3).RESULTS The twenty patients with TBAD were successfully implanted with a covered stent at the proximal breach of dissection through the femoral artery.CTA was reexamined 12 months after operation.The measured diameters of L1[(19.3±2.3)mm vs.(40.6±4.8)mm,P<0.05]、L2[(18.3±2.2)mm vs.(30.32±4.59)mm,P<0.05]、L3[(11.3±1.2)mm vs.(15.2±1.6)mm,P<0.05 were increased compared with those before operation,The measured diameter of plane L1[(21.5±3.3)mm vs.(4.9±2.6)mm,P<0.05]、L2[(21.1±3.0)mm vs.(5.1±2.5)mm,P<0.05]、L3[(18.5±1.3)mm vs.(15.9±1.6)mm,P<0.05]in false cavity decreased compared with that before operation.After stent implantation,the false cavity gradually began to thrombosis.During postoperative follow-up,no serious complications occurred in all patients.CONCLUSION The short and medium-term effect of transcatheter lumen isolation in the treatment of adult TBAD is obvious.3 D printing technology is feasible and effective for preoperative auxiliary evaluation of TBAD patients.