Wang Feng, Yang Xiao-Feng
Department of General Surgery, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China.
Department of Urology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China.
World J Clin Cases. 2020 Dec 6;8(23):5944-5951. doi: 10.12998/wjcc.v8.i23.5944.
Hernia is a common condition requiring abdominal surgery. The current standard treatment for hernia is tension-free repair using meshes. Globally, more than 200 new types of meshes are licensed each year. However, their clinical applications are associated with a series of complications, such as recurrence (10% - 24%) and infection (0.5% - 9.0%). In contrast, 3D-printed meshes have significantly reduced the postoperative complications in patients. They have also shortened operating time and minimized the loss of mesh materials. In this study, we used the myopectineal orifice (MPO) data obtained from preoperative computer tomography (CT)-based 3D reconstruction for the production of 3D-printed biologic meshes.
To investigate the application of multislice spiral CT-based 3D reconstruction technique in 3D-printed biologic mesh for hernia repair surgery.
We retrospectively analyzed 60 patients who underwent laparoscopic tension-free repair for inguinal hernia in the Department of General Surgery of the First Hospital of Shanxi Medical University from September 2019 to December 2019. This study included 30 males and 30 females, with a mean age of 40 ± 5.6 years. Data on the MPO were obtained from preoperative CT-based 3D reconstruction as well as from real-world intraoperative measurements for all patients. Anatomic points were set for the purpose of measurement based on the definition of MPO: A: The pubic tubercle; B: Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the outer edge of the rectus abdominis, C: Intersection of the horizontal line extending from the summit of the inferior edge of the internal oblique and transversus abdominis and the inguinal ligament, D: Intersection of the iliopsoas muscle and the inguinal ligament, and E: Intersection of the iliopsoas muscle and the superior pubic ramus. The distance between the points was measured. All preoperative and intraoperative data were analyzed using the test. Differences with < 0.05 were considered significant in comparative analysis.
The distance between points AB, AC, BC, DE, and AE based on preoperative and intraoperative data was 7.576 ± 0.212 cm 7.573 ± 0.266 cm, 7.627 ± 0.212 cm 7.627 ± 0.212 cm, 7.677 ± 0.229 cm 7.567 ± 0.786 cm, 7.589 ± 0.204 cm 7.512 ± 0.21 cm, and 7.617 ± 0.231 cm 7.582 ± 0.189 cm, respectively. All differences were not statistically significant ( > 0.05).
The use of multislice spiral CT-based 3D reconstruction technique before hernia repair surgery allows accurate measurement of data and relationships of different anatomic sites in the MPO region. This technique can provide precise data for the production of 3D-printed biologic meshes.
疝气是一种常见疾病，需要进行腹部手术。目前疝气的标准治疗方法是使用补片进行无张力修补。在全球范围内，每年有超过200种新型补片获得许可。然而，它们的临床应用会引发一系列并发症，如复发（10% - 24%）和感染（0.5% - 9.0%）。相比之下，3D打印补片显著降低了患者术后并发症的发生率。它们还缩短了手术时间，并使补片材料的损耗最小化。在本研究中，我们利用术前基于计算机断层扫描（CT）的三维重建获取的耻骨肌孔（MPO）数据来制作3D打印生物补片。
探讨基于多层螺旋CT的三维重建技术在3D打印生物补片用于疝气修补手术中的应用。
我们回顾性分析了2019年9月至2019年12月在山西医科大学第一医院普通外科接受腹腔镜腹股沟疝无张力修补术的60例患者。本研究包括30例男性和30例女性，平均年龄为40±5.6岁。所有患者的MPO数据均从术前基于CT的三维重建以及实际术中测量获取。根据MPO的定义设置解剖点用于测量：A：耻骨结节；B：从腹内斜肌和腹横肌下缘顶点延伸的水平线与腹直肌外缘的交点，C：从腹内斜肌和腹横肌下缘顶点延伸的水平线与腹股沟韧带的交点，D：髂腰肌与腹股沟韧带的交点，E：髂腰肌与耻骨上支的交点。测量各点之间的距离。所有术前和术中数据均采用t检验进行分析。在比较分析中，P<0.05的差异被认为具有统计学意义。
基于术前和术中数据，AB、AC、BC、DE和AE点之间的距离分别为7.576±0.212厘米对7.573±0.266厘米，7.627±0.212厘米对7.627±0.212厘米，7.677±0.229厘米对7.567±0.786厘米，7.589±0.204厘米对7.512±0.21厘米，以及7.617±0.231厘米对7.582±0.189厘米。所有差异均无统计学意义（P>0.05）。
在疝气修补手术前使用基于多层螺旋CT的三维重建技术能够准确测量MPO区域不同解剖部位的数据及相互关系。该技术可为制作3D打印生物补片提供精确数据。
