摘要
目的:探讨3D打印技术在诊断和治疗非小细胞肺癌中的应用价值。方法:2014年1月-2015年1月收治的经320排螺旋CT扫描,进行三维重建,3D打印出实体1:0.8大小的患侧肺血管及肺病灶模型,术前制定手术方案且模拟手术过程的32例非小细胞肺癌(NSCLC)患者,经电视胸腔镜应用内镜缝合切割器切除病灶,术中快速冰冻切片明确诊断,行肺段切除术,肺叶切除术。结果:术中证实95%以上的肺血管可被3D打印出来。手术时间(40.5±20.2)min,术中出血量(52.3±30.1)ml。切除淋巴结(7.0±3.1)枚。无术中死亡。术后病理:鳞癌11例,腺癌21例;病理分期:T_(1a)N_0M_08例,T_(1a)N_1M_09例,T_(1b)N_0M_02例,T_(1b)N_1M_04例,T_(2a)N_0M_01例,T_(2a)N_1M_08例。术后肺部感染5例,肺不张3例,经抗炎治疗或负压吸引治愈;心房纤颤2例,给予盐酸胺碘酮(可达龙)后治愈;无其他严重并发症。术后胸腔引流管留置时间(2.2±1.6)d;引流量(134.5±41.2)ml/d。32例随访4-15个月,中位随访时间9.1月,31例无瘤生存,术后10个月发生转移脑转移1例于术后7个月死亡。结论:3D打印技术有助于非小细胞肺癌的诊断和治疗,从而降低手术风险,特别是电视胸腔镜手术。
Objective： To study the value of three-dimensional printing on diagnosis and treatment of non-small cell lung cancer. Methods： 32 NSCLC patients were collected, who were examined with preoperatively 320-detector-row multidetector computed tomography, three-dimensional reconstruction, three-dimensional printing, operative simulation and intraoperative navigation from January 2014 to January 2015, segmentectomy or lobectomy was performed by VATS based on fast frozen sections. Results： It was confirmed that over 95% artery could be found by 3D printing during the operation. The procedure was completed in （40.5 ±20.2） min, the mean blood loss was （52.3 ± 30.1）ml, a mean of （ 7.0 ± 3.1） lymph nodes were resected. There was no death during the procedure. Postoperative pathology showed squamous cell cancer in 11 cases and adenocarcinoma in 21; postoperative pathological staging： 8 cases in TtaNoM0, 9 in TlaN1M0, 2 in T1bNoM0, 4 in TlbN1M0, 1 in T2NoM0, 8 in T2aN1M0. After the surgery, 5 patients developed pulmonary infection, 3 patients with atelectasis were cured by antiinflammatory or vacuum as-piration. 2 with atrial fibrillation were cured by the injection of amiodarone hydrochloride. There was no other severe complication. The mean duration for chest drainage was （ 2.2 ±1.6） d and the mean drainage volume was （134.5 ± 41. 2） ml/d. Among the 32 cases, follow-up was achieved in 31 of them for 4 to 15 months with a median of 9.1 months, during which 31 patients survived without tumor, 1 patient showed brain metastasis 10 months after the procedure and dead in 7 months. Conclusion： Three-dimensional printing is helpful for the diagnosis and treatment of non-small cell lung cancer, it can reduce the operation risks, especially video-assisted thoracic operation.
出处
《中国数字医学》
2016年第1期87-90,共4页
China Digital Medicine
基金
黑龙江省应用技术研究与开发计划项目(编号:GA14C101)~~
关键词
3D打印
电视胸腔镜手术
非小细胞肺癌
three-dimensional printing, video-assisted thoracoscopic surgery, non-small cell lung cancer
