摘要
目的探讨3D打印技术在鼻鼻窦恶性肿瘤切除及术后重建中的应用。方法回顾分析2015年1月~2017年6月我科收治的鼻鼻窦恶性肿瘤并进行手术治疗的10例患者临床病理资料。其中鳞癌4例,骨肉瘤1例,嗅神经母细胞瘤2例,腺样囊性癌2例,黏液表皮样癌1例。所有患者术前均行鼻鼻窦CT扫描,3D重建并打印出病变鼻窦模型,在模型上进行术前设计及模拟手术,确定肿瘤切除范围、需修复重建部位,确定手术方案后进行肿瘤切除及同期重建。术后均予以放疗并密切随访,通过CT复查与功能检查,对疗效、手术精准度及功能恢复进行评价。结果经3D打印术前设计,全部患者顺利完成肿瘤切除术,8例患者同期行缺损部位修复重建,其中6例患者上颌骨和眶壁骨质缺损植入钛网,2例患者颅底骨质缺损较大行鼻中隔黏骨膜瓣修复,2例缺损较小且硬脑膜完整者未行骨性重建。术中能够明确肿瘤与解剖结构的位置关系并实现了全部切除、准确定位缺损并修复,精确度高。术后CT复查显示切除范围、骨缺损部位、重建外形与术前设计基本一致。10例患者术后愈合良好,无严重并发症。患者随访12~30个月,肿瘤无复发。结论 3D打印技术在鼻鼻窦恶性肿瘤的外科治疗中可以实现术前设计、手术模拟及术后预测,具有较好的可行性和可靠性,有助于鼻鼻窦恶性肿瘤切除范围的确定、缺损重建,可提高鼻鼻窦恶性肿瘤手术治疗的精确性、临床治疗效果及患者术后生活质量。
Objective To study the application of three-dimensional （3D） printing technique in the surgical resection of sinonasal malignancies and postoperative defect repair. Methods Clinieopathological data of 10 patients suffering from sinonasal malignant tumors surgically treated in our department from Jan. 2015 to June 2017 were analyzed retrospectively. The sinonasal malignant tumors included squamous carcinoma （ n = 4 ）, osteosarcoma （ n = 1 ） , olfactory neuroblastoma （ n = 2）, adenoid cystic carcinoma （ n = 2）, and mucoepidermoid carcinoma （ n = 1 ）. Before operation, all patients received computerized tomography （CT） scan of nasosinus. 3D images of the affected sinuses were reconstructed, and their 3D models were established and printed. On the 3D models, preoperative design and simulated operation were performed to confirm the resection range as well as the area needs to be repaired. Proper surgical approaches were adopted to implement tumor resection with simultaneous defect repair. All patients were given postoperative radiotherapy and followed up closely. The surgical accuracy and function recovery were evaluated with postoperative CT scan and functional examinations. Results On the basis of 3D preoperative design, tumor resection was successfully achieved in all 10 cases. Of them, simultaneous defect repair was performed in 8 patients, including defect repair of maxilla and/orbital wall withpreformed titanium mesh in 6 and repair of skull base bone defect with nasal septal mucoperiosteal flap in 2. All patients got cured without serious complications. During operation, the position relationships among the tumor and surrounding anatomical structures were defined, complete tumor resection and accurate localization as well as repair of defect were accomplished. Postoperative CT scan showed consistencies of resection range, defect site and reconstructed configuration with those in the preoperative design. All the patients had been followed up for 12 to 30 months, and recurrence occurre
作者
吴昆旻
吴建
朱春晖
殷立平
安静娟
杨祁
李泽卿
WU Kun-min;WU Jian;ZHU Chun-huiI;YIN Li-ping;AN Jing-juan;YANG Qi;LI Ze-qing(Department of Otolaryngology,Second Jiangsu Provincial Hospital of Traditional Chinese Medicine,Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210017,China;Department of Otolaryngology,Changzheng Hospital of Naval Medical University,Shanghai 200003,China)
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2018年第4期361-365,共5页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
基金
江苏省卫计委面上项目(Z201702)
江苏省中医药局科技项目(YB201824)
关键词
鼻鼻窦恶性肿瘤
3D打印
外科手术
修复
Sinonasal malignancy
Three-dimensional （3D） printing
Operation
surgical
Repair
