三维重建及3D打印在微创肺外科中的应用

随着肺癌发病率升高以及低剂量螺旋CT扫描检查的普及,越来越多的肺结节患者被及时诊断。对于此类患者胸腔镜手术是安全可行的,其优势在于创伤小、痛苦少、恢复快,且不增加手术并发症发生,不降低远期疗效。精准外科理念的普及,在肺外科主要体现为胸腔镜下亚肺叶切除术,已成为肺外科手术治疗的发展趋势。但由于肺段血管、支气管均包埋于肺组织内,且解剖结构比较复杂,解剖变异具有明显的个体化差异。术中对肺段支气管、肺血管等解剖结构判断错误,将造成气管损伤、咯血、肺不张等并发症。传统的肺部手术计划以及手术方案的确定,建立在胸部CT等影像资料和术者多年积累的实践经验之上,术者依靠其解剖学知识和空间想象力在大脑中构建肺的三维结构,但普通CT是二维图像,对于精准定位、判断支气管及血管解剖变异、特殊走行等细节问题较为困难。针对这种情况,近年来基于医学影像学和数字医学的三维重建及3D打印技术发展迅速,具有能直观反映肺部病灶的解剖结构、形状大小以及与毗邻组织器官的关系的作用,并能进行术前规划和术中导航等优势,在解剖结构复杂且具有个体化差异的胸腔镜亚肺叶切除术中扮演着重要角色,同时三维重建及3D打印技术在医患沟通、解释病情、临床教学等方面也有着积极的作用。 

Application of three-dimensional reconstruction and 3D printing in minimally invasive lung surgery

With the increasing incidence rate of lung cancer and the popularization of low-dose spiral computed tomography (LDCT) examination, more and more patients with pulmonary nodules are diagnosed in time. Thoracoscopic surgery is safe and feasible for such patients, its advantages are small trauma, less pain, fast recovery, and does not increase the occurrence of surgical complications, nor reduce the long-term effect. The popularization of the concept of precision surgery is mainly reflected in the subpulmonary lobectomy under thoracoscopy, which has become the development trend of pulmonary surgical treatment. However, the vessels and bronchi in the pulmonary segment are all embedded in the lung tissue, and the anatomical structure is relatively complex. The anatomical variation has obvious individual difference. During the operation, the wrong judgment of the pulmonary segment bronchus, pulmonary vessels and other anatomical structures will cause tracheal injury, hemoptysis, atelectasis and other complications. Traditional lung surgery programs and surgical procedures are based on imaging data such as chest CT and years of practical experience accumulated by the surgeon, relying on their knowledge of anatomy and space imagination in the brain to build three-dimensional structure of the lungs, but ordinary CT is two-dimensional images, bronchi and vessels for precise positioning and judgment anatomical variation, special course details such as difficult. In this case, in recent years, the three-dimensional reconstruction and 3D printing technology which based on medical imaging and digital medicine has developed rapidly, which can directly reflect the anatomical structure, shape and size of pulmonary lesions and the relationship with adjacent tissues and organs, and can carry out preoperative planning and intraoperative navigation, and plays an important role in the thoracoscopic subpulmonary lobectomy which has complex anatomical structure and individual differences. At the same time, three-dimensional reconstruction and 3D printing technology also play an active role in doctor-patient communication, interpretation of the disease, clinical teaching and so on.