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目的评估应用3D打印技术指导远离型右室双出口的手术决策、模拟和外科手术的效果。方法我院2012年1月至2013年12月,在3D打印技术指导下12例远离型右室双出口的患者经历治疗决策、手术模拟并最终完成了外科手术矫治,其中男9例、女3例,年龄(2.9±2.2)岁。3D打印技术指导策略包括:超声诊断确诊为远离型右室双出口,CT检查,基于CT的3D格式文件生成,3D打印心脏模型,外科手术模拟,外科手术。在模拟手术时,外科医生根据模型设计补片形状,室间隔缺损扩大方法,肌束切除方案等。8例患者行双心室矫治,4例行单心室矫治。双心室矫治的患者中6例行单纯心内隧道矫治,1例行心内隧道加动脉调转,1例行双根部调转手术。心室内隧道修补均施行了室间隔缺损扩大术。行单心室矫治的原因主要是非常小的限制型室间隔缺损和三尖瓣主要腱索或者乳头肌跨越主动脉瓣下流出道。结果全组患者手术中探查所见和术前3D打印模型相关性很好。无手术死亡,无重大并发症发生。1例患者术后有轻度的主动脉瓣下狭窄。没有随访期死亡和再次手术。参与手术的医生对于3D打印模型满意。结论 3D打印模型对于远离型右室双出口的手术决策能提供很好的帮助,并且通过提供外科手术模拟的术前评估从而减少手术并发症,改善手术结果。
Objective To assess the effect of 3D printing techniques on surgical decisions, simulations and surgical procedures that guide double exit right ventricle. Methods From January 2012 to December 2013 in our hospital, 12 patients with far right ventricular double outlet under the guidance of 3D printing technology underwent treatment decision, surgical simulation and finally surgical correction. There were 9 males and 3 females Cases, age (2.9 ± 2.2) years old. 3D printing techniques include: Diagnostic ultrasound diagnosis of distant right ventricle double outlet, CT examination, CT-based 3D format file generation, 3D printed heart model, surgical simulation, and surgery. Surgery based on the model design patch shape, ventricular septal defect enlargement method, muscle bundle resection program in the simulation surgery. Eight patients underwent biventricular correction, 4 patients underwent single ventricle correction. Six patients underwent biventricular bypass surgery underwent simple heart tunneling, 1 underwent intracardiac tunneling and arterial transfer, and 1 underwent double root resurfacing. Ventricular tunnel repair are implemented ventricular septal defect enlargement. Line single ventricle correction is mainly due to very small restricted ventricular septal defect and the main tricuspid chordae or papillary muscle spill over the aortic valve. Results The findings of the surgical exploration of the whole group of patients were well correlated with the preoperative 3D printing model. No operative death, no major complications. One patient had mild suboptimal aortic stenosis. No follow-up death and reoperation. The doctor involved in the operation was satisfied with the 3D printing model. Conclusion The 3D printing model can be of great help in the surgical decision-making of far-right right ventricle double outlet and can reduce the surgical complications and improve the surgical outcome by providing preoperative evaluation of surgical simulation.