3D打印模型在邻近集合系统肾肿瘤腹腔镜下肾部分切除术中的应用(附20例报告)

The Application of 3D-printing Model for Renal Tumors Approaching the Collection System in Laparoscopic Partial Nephrectomy

目的将3D打印技术应用于近集合系统肾肿瘤的腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN),并验证其可行性和价值。方法 2016年3月至2018年3月本单位行LPN治疗的邻近集合系统肾肿瘤患者20例。其中男性12例,女性8例,年龄(60. 9±9. 6)岁,肿瘤平均直径(3. 5±1. 5) cm,R. E. N. A. L评分7～11分,肿瘤距集合系统距离均≤4mm,术前所有患者行CTA检查,提取CT数据并应用ForlabForm1+按照1∶1比例制作患肾3D模型,术前根据3D打印模型制定个性化手术方案,术中应用3D模型指导优化术中操作,统计分析术中出血量、手术时间、肾热缺血时间、处理集合系统时间等临床资料。结果 20例患者均顺利完成后腹腔镜肾部分切除术,平均手术时间(98. 0±12. 4)分钟,平均热缺血时间(22. 1±3. 8)分钟,平均出血量(78. 0±18. 2) ml,处理集合系统时间(4. 2±1. 4)分钟,术中、术后未输血,无漏尿,所有患者随访6个月无肾积水等并发症。结论近集合系统肾肿瘤的3D打印模型可以清晰明了地显示肾肿瘤解剖,提示肿瘤与集合系统的位置关系,术前可以指导制定个性化手术方案,术中可以指导优化手术操作,降低术中损伤集合系统的风险,对于集合系统损伤无法避免的肾肿瘤,可以指导集合系统缝合,减少处理集合系统时间,避免术后漏尿和局限性肾积水。

Objective To explore the feasibility and value of applying 3 D-printing model to laparoscopic partial nephrectomy of renal tumors approaching collection system. Methods From Mar. 2016 to Mar. 2018,20 cases of renal tumors approaching collection system underwent the laparoscopic partial nephrectomy in our department. Among them,12 patients were males and 8 patients were females,The average patient age was( 60. 9 ± 9. 6) years old,the average diameter of the tumors was( 3. 5 ± 1. 5) cm,the R. E. N. A. L score was( 7 ~ 11) points. The distance between tumor and collection system was no more than 4 mm. All the patients underwent CTA examination before surgery. The CT data were extracted and the 3 D renal models were made with ForlabForm1 + at a ratio of 1∶ 1. The preoperative personalized operation plans were made according to the 3 D printing models,and the application of the 3 D model in surgery could guide the optimization of the operations.The intraoperative blood loss,the operation time,the renal warm ischemia time and other clinical data were statistically analyzed. Results All these 20 cases of laparoscopic partial nephrectomy were successful. The average operation time was( 98. 0 ± 12. 4) minutes,the average renal warm ischemia time was( 22. 1 ± 3. 8)minutes,the average blood loss was( 78. 0 ± 18. 2) ml and the average processing time of collection system was( 4. 2 ± 1. 4) minutes. No blood transfusion nor urine leakage happened during or after operation. All patients were followed up for 6 months with no complications such as local hydronephrosis was observed. Conclusions The 3 D printing model can clearly display the renal tumor anatomy,indicating the location relationship between the tumor and the collection system. It can guide the development of personalized surgical program before surgery and optimize surgical operation during surgery,and reduce the risk of intraoperative damage collection system.For renal tumors that can not be avoided with collection system injury,the 3 D printing model could guide collection system suture,reduce the processing time of collection system,and avoid postoperative leakage of urine and local hydronephrosis.