计算机辅助3D打印技术用于保留乳房手术一期乳房重建

doi:10.3877/cma.j.issn.1674-0807.2018.01.003

中华乳腺病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (01) : 12 -16. doi: 10.3877/cma.j.issn.1674-0807.2018.01.003

所属专题：文献；

论著

计算机辅助3D打印技术用于保留乳房手术一期乳房重建

张聚良¹, 姚青¹, 黄美玲¹, 张明坤¹, 孟慧敏¹, 侯兰¹, 凌瑞¹^,^†(

)

^1. 710032　西安，空军军医大学西京医院甲乳血管外科

收稿日期:2017-09-27 出版日期:2018-02-01
通信作者: 凌瑞
基金资助:
国家自然科学基金资助项目(81572917)

Computer-assisted 3-dimensional printing technology for immediate breast reconstruction after breast-conserving surgery

Juliang Zhang¹, Qing Yao¹, Meiling Huang¹, Mingkun Zhang¹, Huimin Meng¹, Lan Hou¹, Rui Ling¹^,^†()

^1. Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Medical University of Air Force, Xi'an 710032, China

Received:2017-09-27 Published:2018-02-01
Corresponding author: Rui Ling
About author:
Corresponding author: Ling Rui, Email: lingrui0105@163.com

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目的

探讨3D打印可降解软组织材料在乳腺癌保留乳房手术后乳房重建中的应用价值。

方法

利用计算机辅助3D打印技术制作个性化可降解填充材料，对2016年3月6日空军军医大学西京医院收治的1例左侧乳腺浸润性癌(4.0 cm×3.0 cm)患者实施保留乳房手术一期乳房重建。术前应用乳腺MRI平扫加增强扫描采集乳腺影像数据，并用计算机模拟手术后的组织缺损，精确设计填充物大小。将数据导入西安交通大学自主研发的打印系统之后，使用生物可降解材料聚己内酯打印乳房缺损填充物。乳房缺损填充物在术前充分消毒，于乳腺包块切除术后植入乳房缺损处。术后每月评估安全指标(填充物引发的感染和免疫排异反应)、美容效果、组织相容性以及预后情况。

结果

乳房重建后患者未发现有感染、血肿等安全问题，伤口恢复良好。术后9个月复查结果显示：患者乳房美容效果良好；MRI检查显示，填充物与自体组织嵌合，相容性好；功能成像提示，填充物周围血供丰富，有软组织包绕填充物，且有肉芽组织逐渐向填充物内生长。此外，截至2017年12月未出现复发、转移。

结论

3D打印可降解软组织材料可能为保留乳房手术患者乳房重建提供新的方法，值得临床推广。

关键词: 乳腺肿瘤, 乳房成形术, 三维打印

Objective

To explore the application of 3-dimensional (3D) printed biodegradable implants in immediate breast reconstruction after breast-conserving surgery in breast cancer patients.

Methods

One patient with left invasive breast cancer (4.0 cm×3.0 cm), who was admitted in Xijing Hospital, Medical University of Air Force on March 6, 2016, underwent breast-conserving surgery and immediate breast reconstruction. The bio-implant produced by computer-assisted 3D printing technology was used for reconstruction. Imaging data of the breast were collected by breast MRI (plain scanning and enhancement scanning) before operation. The computer simulation was performed to calculate the tissue defect and design the implants meticulously. After data input, the bio-implant was printed by the 3D printer system developed by Xian Jiaotong University, using porous biodegradable material-polycaprolactone. Following sufficient sterilization, the bio-implant was inserted into the defective cavity after tumor resection. Safety indicators (implant-related infection and immunological rejection), cosmetic outcome, autologous compatibility and prognosis were evaluated every month after surgery.

Results

After breast reconstruction, no major complications including infection and hematoma occurred and the wound healed smoothly. Nine months after operation, the breast showed excellent cosmetic outcome and MRI demonstrated good compatibility of implant with autologous tissue. The functional imaging showed that with rich blood supply around, bio-implant was surrounded by soft tissue and some granulation tissue gradually grew into the implant. Until December 2017, no local recurrence and metastasis were reported.

Conclusion

The 3D-printed biodegradable soft tissue material may provide a new way for breast reconstruction after breast-conserving surgery, and is worthy of clinical application.

Key words: Breast neoplasms, Mammaplasty, Three-dimensional printing

图1 乳腺癌患者乳房个性化可降解多孔支架的设计和打印　a图为乳腺磁共振成像正面图；b　图为乳腺磁共振成像侧面图；c　图为模拟肿块大小及手术切除范围；d图为模拟支架形态结构；e图为模拟填充物植入效果图；f　图为填充物打印完成

图2 乳腺癌患者行计算机辅助3D打印可降解材料乳房重建手术　a图为完整切除左侧乳腺癌组织及周围部分正常腺体；b图为测量残腔尺寸；c图为生物材料填充残腔

图3 乳腺癌患者行左侧乳腺区段切除＋打印填充物植入＋腋窝淋巴结清扫术后9个月乳房外观及随访情况　a图为乳房美容效果；b图为乳房磁共振成像图；c图为填充物的磁共振成像图

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