中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (5): 761-764.doi: 10.3969/j.issn.2095-4344.3012

• 组织构建临床实践 clinical practice in tissue construction • 上一篇    下一篇

3D打印共面模板结合固定针技术在肺小结节经皮精准活检中的应用

徐俊马1，喻岳超2，刘  智2，刘  雨2，王飞通3   

  1. 1江苏大学附属金坛人民医院呼吸内科，江苏省常州市   213200；2徐州医科大学第二附属医院核医学科，江苏省徐州市   221000；3徐州医科大学附属医院肿瘤中心，江苏省徐州市  221000
  • 收稿日期:2019-08-13 修回日期:2019-08-15 接受日期:2020-04-15 出版日期:2021-02-18 发布日期:2020-12-01
  • 通讯作者: 王飞通，副主任医师，徐州医科大学附属医院肿瘤中心，江苏省徐州市 221000
  • 作者简介:徐俊马，男，1981年生，江苏省南通市人，汉族，2018年徐州医科大学毕业，硕士，副主任医师，主要从事呼吸系统危重症及肺癌的微创治疗方面的研究。
  • 基金资助:
    江苏省高等学校自然科学研究面上项目(17KJD320004)

Application of 3D-printed coplanar template combined with fixed needle technique in percutaneous accurate biopsy of small pulmonary nodules

Xu Junma1, Yu Yuechao2, Liu Zhi2, Liu Yu2, Wang Feitong3   

  1. 1Department of Respiratory Medicine, Jintan People’s Hospital, Jiangsu University, Changzhou  213200, Jiangsu Province, China; 2Department of Nuclear Medicine, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou  221000, Jiangsu Province, China; 3Cancer Center, Xuzhou Medical University, Xuzhou  221000, Jiangsu Province, China
  • Received:2019-08-13 Revised:2019-08-15 Accepted:2020-04-15 Online:2021-02-18 Published:2020-12-01
  • Contact: Wang Feitong, Associate chief physician, Cancer Center, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • About author:Xu Junma, Master, Associate chief physician, Department of Respiratory Medicine, Jintan People’s Hospital, Jiangsu University, Changzhou 213200, Jiangsu Province, China
  • Supported by:
    the Natural Science Foundation of Jiangsu Universities (General Project), No. 17KJD320004

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摘要：

文题释义：
3D打印技术：是一种新兴的快速成型技术，是以数字模型文件为基础，再给予计算机三维设计模型，通过特殊材料进行逐层堆积粘连成型，改变了传统以模具为蓝本的加工塑形模式。
肺结节：是指影像学表现为直径≤3 cm 的局灶性、类圆形、密度增高的实性或亚实性肺部阴影，可为孤立性或多发性，不伴肺不张、肺门淋巴结肿大和胸腔积液。

背景：经皮肺穿刺活检是明确肺结节性质的重要方法和手段，但是由于呼吸运动的存在，肺脏的活动度较大，经皮肺活检尤其是针对肺小结节的活检存在一定难度。
目的：介绍3D打印共面模板结合固定针技术在肺小结节经皮活检术中的应用。
方法：选择徐州医科大学第二附属医院2018年7月至2019年4月经皮肺活检术患者24例，影像学检查均存在肺小结节，结节直径在8-30 mm之间，根据恶性肿瘤概率评估均为中-高危级，存在经皮肺活检的适应证。采用随机数字表法分为2组，对照组进行徒手穿刺活检，观察组进行3D打印共面坐标模板结合固定针引导穿刺活检，每组12例。统计两组患者术中穿刺针调整次数、CT扫描次数、标本阳性率、并发症发生率等情况。试验获徐州医科大学第二附属医院伦理委员会审批。
结果与结论：①观察组术中活检针调整次数、CT扫描次数、气胸发生率明显低于对照组(P < 0.05)，两组标本取材阳性率与出血并发症比较差异无显著性意义(P > 0.05)；②结果表明，在肺小结节的经皮活检中应用3D打印共面坐标模板结合固定针技术，针对靶病灶起到相对固定作用，能减少术中调整进针次数和CT扫描次数，减少医源性辐射，降低并发症尤其是气胸的发生率。
https://orcid.org/0000-0002-1985-9953 (徐俊马)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 3D打印, 共面模板, 固定针, 肺, 肺结节, 活检, 精准医疗

Abstract: BACKGROUND: Percutaneous lung biopsy is an important method to clarify the nature of lung nodules. However, the lungs are more active due to the presence of respiratory motion. Percutaneous lung biopsy, especially for small lung nodules, is difficult.
OBJECTIVE: To introduce the application of 3D-printed coplanar template combined with fixed needle technique in percutaneous biopsy of small pulmonary nodules.
METHODS: A total of 24 patients who had percutaneous lung biopsy in the Second Affiliated Hospital of Xuzhou Medical University from July 2018 to April 2019 were enrolled. Imaging examination indicated small pulmonary nodules with a nodule diameter of 8-30 mm in all the patients. According to the probability of malignancy, all tumors were of the middle and high risk grade, and there were indications for percutaneous lung biopsy. All the patients were randomized into two groups (n=12 per group): the control group underwent free hand biopsy, and the observation group underwent percutaneous lung biopsy guided by 3D printed coplanar template combined with fixed needle. The number of puncture needle adjustments, number of CT scans, positive rate of specimens, and incidence of complications were recorded and compared between the two groups. Approval for this trial was obtained from the Ethics Committee of the Second Affiliated Hospital of Xuzhou Medical University.
RESULTS AND CONCLUSION: The number of puncture needle adjustments, the number of CT scans and the incidence of pneumothorax during the operation were significantly lower in the observation group than the control group (P < 0.05), whereas there were no significant differences in the positive rate of specimens and incidence of bleeding complications between the two groups (P > 0.05). These findings indicate that the 3D-printed coplanar template combined with fixed needle technique can relatively fix the target lesion, reduce the number of needle adjustments and number of CT scans, reduce iatrogenic radiation, and reduce the incidence of complications, especially pneumothorax.

Key words: 3D printing, coplanar template, fixed needle, lung, lung nodule, biopsy, precision medicine

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