3D打印技术在复杂主动脉疾病腔内治疗中的应用

叶琨?万圣云?丁洋

【摘要】目的 探討三维（3D）打印技术在复杂主动脉疾病腔内治疗中的应用。方法 回顾性分析24例复杂主动脉疾病患者的资料，术前根据24例患者的CT血管造影（CTA）进行主动脉3D重建，将病变区域进行3D打印，选择中空透明材料制作3D打印模型并消毒，术中根据3D打印模型将支架“预开窗”并缝制铂金弹簧圈，重装支架后在体内完成主体支架的释放和分支支架的选择并释放。术后观察疗效、并发症和随访情况。结果 24例包括12例复杂腹主动脉瘤、11例胸主动脉夹层、1例胸腹主动脉瘤，均在术前完成病变段主动脉3D模型打印，根据模型数据辅助制定手术方案，手术均顺利。24例术前3D打印模型测量和术中造影各项数据比较差异均无统计学意义（P均> 0.05）。主动脉夹层患者术后真腔最大直径较术前增大、术后假腔最大直径较术前减小;主动脉瘤患者术后瘤体最大直径较术前减小（P均< 0.05）。所有患者术后均未出现出血、脏器功能损害等严重并发症，术后3个月复查CTA显示支架位置良好，无内漏，分支动脉血供良好。结论 3D打印技术能使复杂主动脉疾病的腔内治疗更加精准。

【关键词】复杂主动脉疾病;腔内治疗;3D打印技术

Application of 3D printing technology in endovascular treatment of complex aortic disease Ye Kun， Wan Shengyun， Ding Yang. Department of Vascular Surgery， the Second Hospital of Anhui Medical University， Hefei 230601， China Corresponding author， Wan Shengyun， E-mail： wshy63@ sina. com

【Abstract】Objective To evaluate the application of three-dimensional （3D） printing technology in the endovascular treatment of complex aortic disease. Methods Clinical data of 24 patients with complex aortic disease were retrospectively analyzed. Three-dimensional reconstruction of the aorta was performed according to preoperative CT angiography （CTA） of 24 patients. The diseased area was subjected to 3D printing. Hollow transparent materials were employed to produce and sterilize 3D printing models. Intraoperatively， pre-fenestration of the stent was carried out and the platinum coils were sewed around the holes of the covered stent based upon the 3D printing models. After stent reassembly， the releasing of the covered stent and the selection and releasing of the branch stent were performed. Postoperative efficacy， complications and follow-up prognosis were observed. Results Among 24 patients， 12 cases were diagnosed with complex abdominal aortic aneurysm， 11 cases of thoracic aortic dissection and 1 case of thoracoabdominal aortic aneurysm. All 3D printing models of the aortic lesion were accomplished preoperatively. The surgical plans were determined based on the data of 3D printing models. All patients successfully underwent the surgery. The data of preoperative 3D printing models did not significantly differ from intraoperative CTA data （all P > 0.05）. For patients with aortic dissection， the maximum diameter of the true lumen was significantly increased， whereas that of the false lumen was considerably decreased after surgery （both P < 0.05）. For aortic aneurysm patients， the maximum diameter of the aneurysm was significantly decreased after surgery （P < 0.05）. No severe complications， such as bleeding or organ failure， occurred postoperatively. CTA at postoperative 3 months showed that the stents were located in proper position， no internal leakage and good blood supply of branch arteries. Conclusion Application of 3D printing technology can enhance the accuracy of endovascular treatment of complex aortic disease.

【Key words】Complex Aortic disease;Endovascular treatment;Three-dimensional printing technology

复杂主动脉疾病的腔内治疗一直是血管外科的难点，包括累及弓上分支的胸主动脉夹层、破口位于内脏区的胸主动脉夹层、胸腹主动脉瘤、复杂腹主动脉瘤等。延长锚定区、保证重要分支动脉血供一直是腔内治疗面临的挑战[1]。而“开窗”“烟囱”“分支支架”“转流”等分支重建技术就是重要的解决手段。“开窗”技术的难点在于位置的确定，仅仅依靠术前影像学方法往往不够精确，容易导致开窗位置和分支支架不匹配，进而影响分支动脉的血运[2]。随着……