Qiu Bin, Ji Ying, He Huayu, Zhao Jun, Xue Qi, Gao Shugeng
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Transl Lung Cancer Res. 2020 Aug;9(4):1235-1246. doi: 10.21037/tlcr-20-571.
Considering the complexity of vascular or bronchial variations and the difficulty of nodule localization during segmental resection, the three-dimensional (3D) reconstruction and printing model can provide a guarantee for safe operation and, to some extent, can simplify the surgical procedure. We conducted this study to estimate the avail of 3D reconstruction and personalized model in anatomical partial-lobectomy (APL).
We prospectively collected and retrospectively reviewed the data of 298 cases who underwent APL in our institute from April 2017 to May 2019. The patients were divided into "3D-reconstruction" group (131 patients), "3D model" group (31 patients) and "non-3D" group (136 patients). We adopted the ANOVA analysis and Chi-square test to compare the perioperative data between the three groups. Subjective satisfaction questionnaires for surgeons were provided to evaluate the value of personalized 3D printed model.
The proportion of complex segmentectomy in 3D model group (87.1%) was significantly higher than that in the 3D-reconstruction group (60.3%) and non-3D group (55.9%) (P=0.006), and the average operation time of complex segmentectomy in 3D model group (99.56 minutes) was significantly shorter than that of the other group (all P<0.05). The average intraoperative blood loss in the 3D model group (12.9 mL) was significantly lower than that in the 3D reconstruction group (20.9 mL) (P=0.001) and non-3D group (18.2 mL) (P=0.022). For simple segmentectomy, the operation time, postoperative drainage, and postoperative hospital stay were similar among the three groups. The questionnaire survey showed that most surgeons were satisfied with the clinical effectiveness of the personalized 3D printed model.
3D printing technology can improve understanding of the anatomy, decrease the operation time, and reduce the potential risk of thoracoscopic anatomical partial lobectomy in stage I lung cancer. A pre-operative rating scale was designed to standardize the application of this technology.
考虑到血管或支气管变异的复杂性以及肺段切除术中结节定位的困难，三维（3D）重建和打印模型可为安全手术提供保障，并在一定程度上简化手术过程。我们开展本研究以评估3D重建和个性化模型在解剖性肺叶部分切除术（APL）中的应用价值。
我们前瞻性收集并回顾性分析了2017年4月至2019年5月在我院接受APL的298例患者的数据。将患者分为“3D重建”组（131例）、“3D模型”组（31例）和“非3D”组（136例）。我们采用方差分析和卡方检验比较三组的围手术期数据。提供外科医生主观满意度问卷以评估个性化3D打印模型的价值。
3D模型组复杂肺段切除术的比例（87.1%）显著高于3D重建组（60.3%）和非3D组（55.9%）（P = 0.006），3D模型组复杂肺段切除术的平均手术时间（99.56分钟）显著短于其他组（均P < 0.05）。3D模型组的平均术中出血量（12.9 mL）显著低于3D重建组（20.9 mL）（P = 0.001）和非3D组（18.2 mL）（P = 0.022）。对于简单肺段切除术，三组的手术时间、术后引流量和术后住院时间相似。问卷调查显示，大多数外科医生对个性化3D打印模型的临床效果满意。
3D打印技术可提高对解剖结构的理解，缩短手术时间，并降低I期肺癌胸腔镜解剖性肺叶部分切除术的潜在风险。设计了术前评分量表以规范该技术的应用。
