CAJ | 학술논문

目的探讨3D打印技术在肾肿瘤肾部分切除术规划中的应用效果及在医患沟通中的作用. 方法 2013年6月至2014年1月对收治的10例拟行腹腔镜下肾部分切除术的T1期肾肿瘤患者的肾脏进行3D打印.肿瘤位于左肾3例,右肾7例.位于肾上极5例,肾下极3例,肾门部2例.T1a期4例,T1b期6例.采用64层螺旋CT对患者进行平扫+增强扫描,扫描结束后进行薄层重建.提取患者CT检查结果的DICOM格式文件,使用三维医学影像数据处理平台进行后处理,然后采用热塑性塑料进行3D打印获得患者肾脏的3D打印模型.打印完成后对模型进行着色处理:肾脏为粉红色,肾集合系统及输尿管为黄色,肾动脉为红色,肾静脉为蓝色,肾肿瘤为玫瑰红色.设计分别针对医学专业人员和患者的开放性调查问卷,作为评价工具验证模型的逼真性和有用性.请4名泌尿外科腹腔镜手术专家使用针对医学专业人员的问卷对模型的逼真性及有用性进行评分,2名术者于术后对3D打印模型规划的手术效果进行反馈评分.测量肿瘤最大径并与3D打印模型进行对比.使用患者个性化肾脏模型与患者或指定家属进行术前谈话,使用针对患者的问卷对谈话效果评分.结果成功打印出10例患者的肾脏3D模型,肾脏的血管、集合系统,肿瘤的大小、位置以及肾脏与肿瘤的关系均显示良好.10例手术均顺利完成.4名专家和2名术者对3D打印模型的逼真性和有用性的总体评分为(7.8±0.7)分.2名术者对3D打印模型手术规划效果的反馈评分为7.5分.经测量,肿瘤真实最大径与3D打印模型最大径误差约(3.4±1.3) mm.患者对3D打印模型用于手术交流的满意度评分为(9.0±0.8)分. 结论 3D打印模型能够很好地显示肿瘤与肾脏的关系,并可以有效帮助医生进行手术规划,还可以用作与患者交流的工具,使医患沟通变得顺畅.
목적 탐토3D타인기술재신종류신부분절제술규화중적응용효과급재의환구통중적작용. 방법 2013년6월지2014년1월대수치적10례의행복강경하신부분절제술적T1기신종류환자적신장진행3D타인.종류위우좌신3례,우신7례.위우신상겁5례,신하겁3례,신문부2례.T1a기4례,T1b기6례.채용64층라선CT대환자진행평소+증강소묘,소묘결속후진행박층중건.제취환자CT검사결과적DICOM격식문건,사용삼유의학영상수거처리평태진행후처리,연후채용열소성소료진행3D타인획득환자신장적3D타인모형.타인완성후대모형진행착색처리:신장위분홍색,신집합계통급수뇨관위황색,신동맥위홍색,신정맥위람색,신종류위매괴홍색.설계분별침대의학전업인원화환자적개방성조사문권,작위평개공구험증모형적핍진성화유용성.청4명비뇨외과복강경수술전가사용침대의학전업인원적문권대모형적핍진성급유용성진행평분,2명술자우술후대3D타인모형규화적수술효과진행반궤평분.측량종류최대경병여3D타인모형진행대비.사용환자개성화신장모형여환자혹지정가속진행술전담화,사용침대환자적문권대담화효과평분.결과 성공타인출10례환자적신장3D모형,신장적혈관、집합계통,종류적대소、위치이급신장여종류적관계균현시량호.10례수술균순리완성.4명전가화2명술자대3D타인모형적핍진성화유용성적총체평분위(7.8±0.7)분.2명술자대3D타인모형수술규화효과적반궤평분위7.5분.경측량,종류진실최대경여3D타인모형최대경오차약(3.4±1.3) mm.환자대3D타인모형용우수술교류적만의도평분위(9.0±0.8)분. 결론 3D타인모형능구흔호지현시종류여신장적관계,병가이유효방조의생진행수술규화,환가이용작여환자교류적공구,사의환구통변득순창.
Objective To investigate the efficacy of using three-dimensional (3D) printing technique on surgical planning and its function in enhancing the physician-patient rapport before surgery.Methods From June 2013 to January 2014,10 patients with T1 renal tumors,who were received laparoscopic partial nephrectomy,were selected in study.Left renal tumor was found in 3 cases and right renal tumor was found in 7 cases.The location of tumor included upper part of kidney in 5 cases,lower part of kidney in 3 cases and renal hilum in 2 cases,4 cases were diagnosed as T1a stage and 6 cases were diagnosed as T1b stage.64-slice enhanced CT scan was performed preoperatively.Data of DICOM format was sent for post processing.The final data was then output to 3 d printer for generating kidney models using thermoplastic plastics.After generating the model,different colors were put on the model,including pink in kidney,yellow in pelvis and ureter,red in renal artery and blue in renal vein.Plotted questionnaires were designed for medical professionals and patients,respectively.4 urological experts make the scores by this questionnaire in order to evaluate the efficacy and fidelity of the model.2 surgeons evaluated the efficacy of model after operation by comparing the actual tumor size with that measured on the models.Meanwhile,the model was used for conversation before operation.The questionnaires were also used for evaluating the effectiveness of conversion.Results 10 kidney models fabricated successfully with 3D-printing.The tumor size,position,renal vascular and collecting system could be clearly presented.Being evaluated by 4 experts and 2 performing urologists,and the mean scores was 7.8 ± 0.7.Intraoperative correlation was advocated by the performing urologists.The mean evaluation score was 7.5.The bias between real diameter of renal carcinoma and that of 3 d model was 3.4± 1.3 mm.Patients and family members preferred the demonstration of the disease and the procedure with a visual and tactile " diseased organ".The scores of satisfactory were 9.0 ± 0.8.Conclusions The 3d printed model could exhibit the relationship between tumor and renal,clearly.It can help the urologists in making surgical plan,effectively.Patients' Understandings from patients and family members of the disease and the procedure to be used can be upgraded with this novel technology.