3D打印技术在房间隔缺损诊疗中的应用价值

发布时间：2018-02-21 13:57

本文关键词： 3D打印技术房间隔缺损介入封堵术动脉导管未闭封堵器　出处：《北京协和医学院》2016年硕士论文　论文类型：学位论文

【摘要】：背景：3D打印技术是一种以数字文件模型为基础,以不同的方法对原材料进行离散、堆积从而完成模型的成形与制造的技术。这项综合了数字建模技术、机电控制技术、信息技术、材料科学与化学等诸多尖端科技的制造业技术实现了从平面打印到立体成型的过程。同时,随着医学朝向精准化、个体化方向发展,3D打印技术已在包括心血管疾病领域在内的诸多医学领域越来越受关注并且展示了它独特的价值和广阔的应用前景。目的：应用3D打印技术制作房间隔缺损解剖模型,探讨3D打印模型在房间隔缺损诊疗中的临床应用价值。方法：回顾性分析2013年10月至2016年3月于我院就诊的33例继发孔型ASD患者的临床资料。所有患者均行心脏冠状动脉CTA检查,并将获取的CT扫描原始数据输入3D Medicine软件(影像数据处理软件)进行三维重建,将重建数据输入美国MakerBot公司熔融沉积技术型3D打印机进行打印。根据3D打印模型进行模拟介入治疗并制定介入手术方案。测量3D打印模型的ASD直径并与超声、CT及封堵器腰径进行比较以评价模型的精确性。结果：1.33例继发孔型ASD模型均制作成功,包括6例中央型ASD(2例伴膨凸瘤形成)、7例多孔型ASD(4例伴房间隔膨凸瘤形成,1例合并下腔型ASD)、6例上腔型ASD(均合并右上肺静脉异位引流至上腔静脉,其中1例伴右中肺静脉引流至右心房上缘)以及14例下腔型ASD,与影像学诊断一致。2.所有病例术前对其3D打印“标本”即模型进行研究分析并行模拟介入治疗,发现对下腔型ASD使用PDA封堵器进行封堵其贴壁情况和稳定性效果较好；6例上腔型ASD,根据3D模型设计出3种覆膜支架,经模拟介入治疗试验,显示出良好的临床应用前景；对多孔型或合并房间隔膨凸瘤的ASD,模型可直观显示缺损的位置、大小与周围组织结构的关系,有助于术前封堵器的选择。3.16例ASD实施介入治疗：包括2例中央型、7例多孔型、7例下腔型ASD,其中15例封堵成功,1例下腔型ASD因缺损直径过大转行外科手术。4.11例ASD(4例中央型、7例下腔型ASD)由于缺损直径过大或结构特殊而未行介入治疗。5.3D打印模型具有较高的精确性：33例ASD患者的3D打印模型测量值与TTE测量值相关系数为r=0.821(P0.001),与CT横断面测量值相关系数为r=0.835(P0.001),15例封堵成功患者术后X线胸片封堵器腰径与相应3D打印模型测量值的相关系数为r=0.902(P0.001)。结论：3D打印ASD解剖模型在技术上具有可行性,对结构复杂的ASD可通过术前模拟介入治疗提高手术成功率或提供新的治疗思路,对特殊及复杂性病例的个性化治疗有较大帮助。
[Abstract]:Background: 3D printing technology is a kind of technology which is based on digital file model and discretizes raw materials in different ways to complete the forming and manufacturing of the model. This technology combines digital modeling technology and electromechanical control technology. Information technology, material science, chemistry and many other cutting-edge manufacturing technologies have achieved the process from plane printing to stereotyping. At the same time, as medicine moves toward precision, The development of individualized 3D printing technology has attracted more and more attention in many medical fields, including cardiovascular diseases, and has shown its unique value and broad application prospects. Anatomic model of atrial septal defect, To explore the clinical value of 3D printing model in diagnosis and treatment of atrial septal defect (ASD). Methods: the clinical data of 33 patients with secondary perforated ASD from October 2013 to March 2016 were analyzed retrospectively. All patients underwent cardiac surgery. Coronary CTA, The original data obtained from CT scan are input into 3D Medicine software (image data processing software) for 3D reconstruction. The reconstructed data was input into MakerBot's fused deposition technology 3D printer for printing. The 3D printing model was used to simulate the interventional therapy and the interventional operation was made. The ASD diameter of the 3D print model was measured and compared with the ultrasonic CT and CT. The waist diameter of occluder was compared to evaluate the accuracy of the model. Results 1. 33 cases of secondary pore ASD model were made successfully. There were 6 cases of central type ASD(2 with bulge tumor and 7 cases of porous ASD(4 with atrial septal bulging tumor. One case was associated with inferior lumen type of ASD(2 and 6 cases with superior lumen type of ASD(2 (all with right superior pulmonary vein ectopic drainage superior vena cava). One case with right middle pulmonary vein draining to the upper edge of right atrium) and 14 cases with inferior lumen ASD were in agreement with imaging diagnosis. 2. All cases were studied and analyzed with 3D printed "specimen" before operation and simulated interventional therapy. It was found that the application of PDA occluder to the lower cavity type of ASD had better adhesion and stability effect. According to the 3D model, three kinds of covered stents were designed, and the results showed a good prospect of clinical application after simulated interventional therapy. For porous ASD or ASD with atrial septal bulge tumor, the model can visualize the location and size of the defect and its relationship with the surrounding tissue structure. The choice of occluder was helpful for preoperative occluder selection. 3.16 cases of ASD were performed interventional therapy, including 2 cases of central type and 7 cases of porous type, 7 cases of inferior cavity type, of which 15 cases were successfully occluded and 1 case of inferior cavity type ASD turned to surgery because of the defect diameter too large. 4.11 cases of ASD(4 cases were successfully occluded. The accuracy of 3D printing model without interventional therapy in 7 patients with central type ASD is higher than that in 33 patients with ASD. The correlation coefficient between the measured value of 3D print model and that of TTE is r = 0.821, P 0.001, and it has a correlation coefficient with CT transverse value. The correlation coefficient of cross-sectional measurement value was r = 0.835 / P 0.001. The correlation coefficient between the waist diameter of chest film occluder and the measured value of 3D print model was 0.902 / P0.0010.Conclusion the ASD anatomical model of ASD with 3 D printing is technically feasible, and the correlation coefficient between the measured value and the measured value of the 3D print model is 0. 902, P 0. 001. Conclusion: the anatomical model of ASD is technically feasible. ASD with complex structure can improve the success rate of operation or provide a new way of treatment by simulated interventional therapy before operation. It is helpful for individualized treatment of special and complicated cases.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.1;TP391.73

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