Alyaev Yu G, Sirota E S, Bezrukov E A, Fiev D N, Bukatov M D, Letunovskii A V, Byadretdinov I Sh
I.M. Sechenov First MSMU of Minzdrav of Russia, Research Institute of Uronephrology and Human Reproductive Health, Moscow, Russia.
Urologiia. 2017 Dec(6):12-19.
To evaluate the possibility of using 3D-printing in the management of patients with localized kidney cancer.
The study comprised five patients with localized kidney cancer who were treated at the Urology Clinic of the I.M. Sechenov First Moscow State Medical University from January 2016 to April 2017. Along with the standard examination, the patients underwent multispiral computed tomography (MSCT) to produce patient-specific 3D-printed models of the kidney tumors using 3D modeling and 3D printing. To evaluate the effectiveness of using 3D-printed models, two-stage preoperative planning was conducted, and five surgeons were surveyed using a four-question multiple choice questionnaire. At the first stage, the planning of operations was carried out based on MSCT findings. At the second stage, the surgeons were given patient-specific soft 3D models of the kidney with a tumor for preoperative training. After preoperative training, patients underwent laparoscopic resection of the kidney with a tumor.
According to the survey results, each of the participating surgeons at least once changed surgical plan based on data obtained with 3D printed models of the kidney with the tumor. The implementation of preoperative training using 3D printed models of the kidney turned out to be effective. All patients underwent laparoscopic surgery performed by a single surgeon with extensive experience in this type of surgery. The mean operative time was 187 minutes. All operations were performed with main renal artery occlusion. The men warm ischemia time was 19.5 minutes and the mean blood loss was 170 ml. There were no conversions to open surgery and organ-removing operations. There were no postoperative complications or deaths. All surgical margins were negative. Morphological examination showed that four patients had renal cell carcinoma one patient had the oncocytoma.
The study demonstrated the promise of using 3D printing for preoperative planning and surgical performance due to a high-precision three-dimensional soft patient-specific model of the localized kidney.
评估3D打印技术在局限性肾癌患者治疗中的应用可能性。
本研究纳入了2016年1月至2017年4月在莫斯科第一国立谢马什克医科大学泌尿外科诊所接受治疗的5例局限性肾癌患者。除了标准检查外，患者还接受了多排螺旋计算机断层扫描（MSCT），以便使用3D建模和3D打印技术制作患者特异性的肾脏肿瘤3D打印模型。为了评估3D打印模型的有效性，进行了两阶段的术前规划，并使用一份包含四个问题的多项选择题问卷对五名外科医生进行了调查。在第一阶段，根据MSCT结果进行手术规划。在第二阶段，为外科医生提供带有肿瘤的患者特异性肾脏软质3D模型用于术前训练。术前训练后，患者接受了腹腔镜下肾肿瘤切除术。
根据调查结果，每位参与的外科医生至少有一次根据肿瘤肾脏的3D打印模型所获得的数据改变了手术方案。结果表明，使用肾脏3D打印模型进行术前训练是有效的。所有患者均由一位在此类手术方面经验丰富的外科医生进行腹腔镜手术。平均手术时间为187分钟。所有手术均在肾动脉主干阻断下进行。男性患者的平均热缺血时间为19.5分钟，平均失血量为170毫升。没有转为开放手术或器官切除手术的情况。没有术后并发症或死亡病例。所有手术切缘均为阴性。病理检查显示，4例患者为肾细胞癌，1例患者为嗜酸细胞瘤。
该研究表明，由于能制作高精度的局限性肾脏患者特异性三维软质模型，3D打印技术在术前规划和手术操作方面具有应用前景。
