Alraiyes Abdul Hamid, Avasarala Sameer K, Machuzak Michael S, Gildea Thomas R
Department of Pulmonary, Critical Care and Sleep Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
AME Med J. 2019 Feb;4. doi: 10.21037/amj.2019.01.05. Epub 2019 Feb 13.
It has been 30 years since the first commercial three-dimensional (3D) printer was available on market. The technological advancement of 3D printing has far exceeded its implementation in medicine. The application of 3D printing technology has the potential of playing a major role within interventional pulmonology; specifically, in the management of complex airway disease. Tailoring management to the patient-specific anatomical malformation caused by benign or malignant disease is a major challenge faced by interventional pulmonologists. Such cases often require adjunctive therapeutic procedures with thermal therapies followed by dilation and airway stenting to maintain the patency of the airway. Airway-stent size matching is one key to reducing stent-related complications. A major barrier to matching is the expansion of the stent in two dimensions (fixed sizes in length and diameter) within the deformed airway. Additional challenges are created by the subjective oversizing of the stent to reduce the likelihood of migration. Improper sizing adversely affects the stability of the stent. The stent-airway mismatch can be complicated by airway erosion, perforation, or the formation of granulation tissue. Stents can migrate, fracture, obstruct, or become infected. The use of patient-specific 3D printed airway stents may be able to reduce the stent airway mismatch. These stents allow more precise stent-airway sizing and minimizes high-pressure points on distorted airway anatomy. In theory, this should reduce the incidence of the well-known complications of factory manufactured stents. In this article, the authors present the brief history of 3D printed stents, their consideration in select patients, processing steps for development, and future direction.
自第一台商用三维（3D）打印机投放市场以来，已经过去了30年。3D打印的技术进步远远超过了其在医学领域的应用。3D打印技术在介入肺脏病学中具有发挥重要作用的潜力；特别是在复杂气道疾病的管理方面。根据由良性或恶性疾病引起的患者特异性解剖畸形来定制治疗方案，是介入肺脏病学家面临的一项重大挑战。此类病例通常需要采用热疗等辅助治疗程序，随后进行扩张和气道支架置入术，以维持气道通畅。气道支架尺寸匹配是减少支架相关并发症的关键之一。匹配的一个主要障碍是支架在变形气道内的二维扩张（长度和直径为固定尺寸）。为降低支架移位的可能性而主观选择过大尺寸的支架，会带来更多挑战。尺寸不当会对支架的稳定性产生不利影响。支架与气道不匹配可能会因气道侵蚀、穿孔或肉芽组织形成而变得复杂。支架可能会移位、断裂、阻塞或感染。使用患者特异性3D打印气道支架或许能够减少支架与气道的不匹配。这些支架能够实现更精确的支架与气道尺寸匹配，并将扭曲气道解剖结构上的高压点降至最低。从理论上讲，这应该会降低工厂制造支架常见并发症的发生率。在本文中，作者介绍了3D打印支架的简要历史、在特定患者中的考量、开发的处理步骤以及未来方向。
