3D打印技术在鼻鼻窦恶性肿瘤外科中的应用

 目的探讨3D打印技术在鼻鼻窦恶性肿瘤切除及术后重建中的应用。方法回顾分析2015年1月~2017年6月我科收治的鼻鼻窦恶性肿瘤并进行手术治疗的10例患者临床病理资料。其中鳞癌4例，骨肉瘤1例，嗅神经母细胞瘤2例，腺样囊性癌2例，黏液表皮样癌1例。所有患者术前均行鼻鼻窦CT扫描，3D重建并打印出病变鼻窦模型，在模型上进行术前设计及模拟手术，确定肿瘤切除范围、需修复重建部位，确定手术方案后进行肿瘤切除及同期重建。术后均予以放疗并密切随访，通过CT复查与功能检查，对疗效、手术精准度及功能恢复进行评价。结果经3D打印术前设计，全部患者顺利完成肿瘤切除术，8例患者同期行缺损部位修复重建，其中6例患者上颌骨和眶壁骨质缺损植入钛网，2 例患者颅底骨质缺损较大行鼻中隔黏骨膜瓣修复，2例缺损较小且硬脑膜完整者未行骨性重建。术中能够明确肿瘤与解剖结构的位置关系并实现了全部切除、准确定位缺损并修复，精确度高。术后CT复查显示切除范围、骨缺损部位、重建外形与术前设计基本一致。10例患者术后愈合良好，无严重并发症。患者随访12~30个月，肿瘤无复发。结论3D打印技术在鼻鼻窦恶性肿瘤的外科治疗中可以实现术前设计、手术模拟及术后预测，具有较好的可行性和可靠性，有助于鼻鼻窦恶性肿瘤切除范围的确定、缺损重建，可提高鼻鼻窦恶性肿瘤手术治疗的精确性、临床治疗效果及患者术后生活质量。

Application of three dimensional printing technique in the surgical treatment of sinonasal malignancies

 ObjectiveTo study the application of three dimensional (3D) printing technique in the surgical resection of sinonasal malignancies and postoperative defect repair.MethodsClinicopathological data of 10 patients suffering from sinonasal malignant tumors surgically treated in our department from Jan. 2015 to June 2017 were analyzed retrospectively. The sinonasal malignant tumors included squamous carcinoma (n=4), osteosarcoma (n=1), olfactory neuroblastoma (n=2), adenoid cystic carcinoma (n=2), and mucoepidermoid carcinoma (n=1). Before operation, all patients received computerized tomography (CT) scan of nasosinus. 3D images of the affected sinuses were reconstructed, and their 3D models were established and printed. On the 3D models, preoperative design and simulated operation were performed to confirm the resection range as well as the area needs to be repaired. Proper surgical approaches were adopted to implement tumor resection with simultaneous defect repair. All patients were given postoperative radiotherapy and followed up closely. The surgical accuracy and function recovery were evaluated with postoperative CT scan and functional examinations.ResultsOn the basis of 3D preoperative design, tumor resection was successfully achieved in all 10 cases. Of them, simultaneous defect repair was performed in 8 patients, including defect repair of maxilla and/orbital wall with preformed titanium mesh in 6 and repair of skull base bone defect with nasal septal mucoperiosteal flap in 2. All patients got cured without serious complications. During operation, the position relationships among the tumor and surrounding anatomical structures were defined, complete tumor resection and accurate localization as well as repair of defect were accomplished. Postoperative CT scan showed consistencies of resection range, defect site and reconstructed configuration with those in the preoperative design. All the patients had been followed up for 12 to 30 months, and recurrence occurred in none.ConclusionWith advantages of being able to implement preoperative design, simulated operation and postoperative prediction, 3D printing technique is feasible and reliable for the surgical treatment of sinonasal malignancies, which may facilitate confirmation of resection range and defect repair, and therefor improve the surgical accuracy and therapeutic effect.