剖面3D打印技术辅助微导管塑形在颅内动脉瘤介入栓塞术中的应用

doi:10.3877/cma.j.issn.2095-9141.2019.05.007

目的

探讨剖面3D打印技术辅助微导管塑形在颅内动脉瘤介入栓塞术中的应用及效果。

方法

选取大连大学附属中山医院神经外科自2015年5月至2019年5月收治的未破裂经行头颈部CTA示颈内动脉后交通动脉瘤患者60例，采取随机抽签方式分为试验组和对照组，每组30例。试验组采用剖面3D打印技术辅助术前塑形微导管栓塞治疗颅内动脉瘤，对照组采用传统介入栓塞治疗颅内动脉瘤。比较2组患者术前准备时间、术中操作时间、住院天数以及改良Rankin量表（mRs）评分评估患者预后。

结果

试验组术前微导管均达到精准塑形，介入栓塞过程顺利，预后良好，术前准备时间（1.837±0.404）h，术中操作时间（30.700±2.680）min，住院天数（6.970±1.450）d，mRs评分为1[0，2]分。而对照组中2例微导管未到位，栓塞失败，1例栓塞时间超过60 min，1例患者因出现肺内感染、右肺大量胸腔积液行右侧胸腔闭式引流术导致住院天数超过30 d，术前准备时间（2.323±0.261)min，术中操作时间（49.530±4.297）min，住院天数（9.500±4.049）d，mRs评分为2[0，5]分。2组术前准备时间、术中操作时间、住院天数以及mRs评分差异有统计学意义（P<0.05)。

结论

应用剖面3D打印技术辅助术前塑形微导管应用于颅内动脉瘤介入栓塞治疗中，不仅便于精准塑形，同时也能降低患者术后并发症的发生率，更能促进神经外科教学模式改革。

关键词: 3D打印技术, 微导管塑形, 颅内动脉瘤, 介入栓塞

Objective

To investigate the application and effect of profile 3D printing assisted microcatheter shaping in interventional embolization of intracranial aneurysms.

Methods

Sixty cases of unruptured posterior communicating carotid artery aneurysms showed by head and neck CTA in the Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University from May 2015 to May 2019 were selected. The patients were divided into experimental group and control group by random lottery, with 30 cases in each group. The experimental group used profile 3D printing technology to assist preoperative shaping microcatheter embolization for intracranial aneurysms treating, while the control group used traditional interventional embolization for intracranial aneurysms treating. Preoperative preparation time, intraoperative operation time, length of stay and mRs scores of the 2 groups were compared to evaluate the prognosis of the patients.

Results

The preoperative microcatheter in the experimental group achieved accurate shaping, the interventional embolization process was smooth, and the prognosis was good, the preoperative preparation time was (1.837±0.404) h, the intraoperative operation time was (30.700±2.680) min, the length of stay was (6.970±1.450) d, and the mRs score was 1[0, 2]. While the control group of 30 cases, 2 embolisms failed, for their microcatheter was not in place; 1 case of embolization lasted more than 60 min, because of lung infection; 1 case of patients characterized by a large number of pleural effusion in the right lung was performed closed drainage, which caused more than 30 hospitalization days, preoperative preparation time was (2.323±0.261) min, intraoperative operating time was (49.530±4.297) min, hospitalization days was (9.500±4.049) d. The mRs score was 2[0, 5]. There were statistically significant differences in preoperative preparation time, intraoperative operation time, length of stay and mRs scores between the two groups (P<0.05).

Conclusion

The application of profile 3D printing technology to assist the application of preoperative shaping microcatheter in the interventional embolization treatment of intracranial aneurysms is not only convenient for accurate shaping, but also can reduce the incidence of postoperative complications of patients and promote the reform of neurosurgery teaching mode.

Key words: 3D printing technology, Microcatheter shaping, Intracranial aneurysms, Interventional embolization

表1 2组不同微导管塑形方法对颅内动脉瘤栓塞术评价指标的影响

组别	例数	术前准备时间(h)	术中操作时间(min)	住院天数(d)	mRs评分（分）
试验组	30	1.837±0.404	30.700±2.680	6.970±1.450	1[0,2]
对照组	30	2.323±0.261	49.530±4.297	9.500±4.049	2[0,5]
t值	?	5.544	20.369	3.226	3.052
P值	?	0.001	0.001	0.020	0.002

表1 2组不同微导管塑形方法对颅内动脉瘤栓塞术评价指标的影响

组别	例数	术前准备时间(h)	术中操作时间(min)	住院天数(d)	mRs评分（分）
试验组	30	1.837±0.404	30.700±2.680	6.970±1.450	1[0,2]
对照组	30	2.323±0.261	49.530±4.297	9.500±4.049	2[0,5]
t值	?	5.544	20.369	3.226	3.052
P值	?	0.001	0.001	0.020	0.002

图1 左侧颈内动脉后交通动脉瘤患者术前术后资料

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Application of profile 3D printing assisted microcatheter shaping in interventional embolization of intracranial aneurysms

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Application of profile 3D printing assisted microcatheter shaping in interventional embolization of intracranial aneurysms