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目的探讨联合应用3D打印技术及术中超声精确定位辅助腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的可行性。方法 2014年3月至2016年3月,应用3D打印技术联合术中超声定位辅助腹腔镜下肾部分切除术治疗完全内生型肾肿瘤患者15例,术前均采用CT三维影像重建并用Formlab Form1+3D打印机进行3D模型打印。所有患者中男11例、女4例,年龄(55.7±10.5)岁,肿瘤直径(2.8±1.0)cm,腹侧3例、背侧12例,均为单发肿瘤。统计分析术中出血量、热缺血时间、术后病理和切缘以及术后肾功能变化情况等临床资料。结果 15例完全内生型肾肿瘤患者均顺利完成腹腔镜下肾部分切除术。平均手术时间(105.0±20.6)min,平均热缺血时间(22.8±3.5)min,平均术中出血量(87.3±15.8)mL。术中及术后均未输血,术后平均住院(6.7±1.0)d。术后未发生明显并发症。手术切缘均阴性,13例患者为透明肾细胞癌,2例为乳头状肾细胞癌。随访(23.7±11.8)个月,未见持续肾功能恶化,无肿瘤复发。结论完全内生型肾肿瘤患者术前应用3D打印技术能明确肿瘤位置及毗邻关系,通过指导手术方案的制定控制手术风险。利用3D打印肾脏模型宣教能改善患者对手术的认知,简化术前谈话流程。进一步通过术中超声对肿瘤切除方案进行修正及优化,可减少肾血管和集合系统的损伤,达到保证切缘阴性和肾功能最大化保留的临床效果。
Objective To explore the feasibility of combined application of 3D printing technology and intraoperative ultrasound-assisted laparoscopic partial nephrectomy in the treatment of completely endogenous renal tumors. Methods From March 2014 to March 2016, 15 cases of complete endoscopic nephrectomy were treated with 3D printing technique combined with intraoperative ultrasound in the laparoscopic partial nephrectomy. Three-dimensional images were reconstructed with CT and Formlab Form1 + 3D printer for 3D model printing. All patients included 11 males and 4 females, with a mean age of (55.7 ± 10.5) years, tumor diameter (2.8 ± 1.0) cm, ventral and dorsal flaps. Statistical analysis of bleeding, warm ischemia time, postoperative pathology and margins and postoperative renal function changes and other clinical data. Results All 15 cases of complete endogenous renal tumors were successfully completed laparoscopic partial nephrectomy. The mean operative time (105.0 ± 20.6) min, average warm ischemia time (22.8 ± 3.5) min, mean operative blood loss (87.3 ± 15.8) mL. No intraoperative and postoperative blood transfusion, the average postoperative hospitalization (6.7 ± 1.0) d. No significant postoperative complications. Surgical margin was negative, 13 cases of clear renal cell carcinoma, 2 cases of papillary renal cell carcinoma. Follow-up (23.7 ± 11.8) months, no continuous deterioration of renal function, no tumor recurrence. Conclusions The application of 3D printing technology in preoperative 3D endoscopic nephrectomy can clarify tumor location and adjacent relationship and control the surgical risk by guiding the development of surgical plans. Using 3D-printed kidney models to teach can improve patient awareness of surgery and streamline preoperative conversations. By intraoperative ultrasound to correct and optimize the tumor resection program, can reduce the renal vascular and collection system damage, to ensure the negative margins and retain the maximum clinical efficacy of renal function.