用于先天性门-系统分流手术规划的 3D 打印模型:病例报告

Sergio Assia-Zamora, Miriam Cortés-Cerisuelo, Athanasios Tyraskis, Nigel Heaton
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引用次数: 0

摘要

导言由于肝脏解剖结构的复杂多变,肝胆外科手术具有挑战性,尤其是对小儿而言。先天性门静脉分流(CPS - Abernethy 综合征)的临床表现和相关并发症越来越多,给手术关闭分流带来了解剖学上的挑战。三维打印(3DP)能够根据患者的具体解剖特征制作精确的模型,因此越来越受欢迎。我们利用原始图像资源制作了一个 3DP 模型,用于规划一名 CPS 患儿的手术分流关闭,并对家属和手术团队进行术前教育。病例介绍一名 5 岁男性患者患有自闭症和 80 μmol/L 的高氨血症,被发现患有肝内 CPS。肝内未见肿瘤。体格检查无异常。在接受利福昔明治疗以降低血氨水平后,他集中注意力和达到里程碑的能力有所改善。分流闭塞的血管造影显示,左侧门静脉和肝中静脉之间有肝内分流进入 IVC。肝门静脉内分支也被显示出来,这意味着可以进行一期闭合。根据横截面成像打印出的 3DP 模型可以更详细地规划分流结扎手术,并向家长解释手术细节。结论 3DP 模型是规划复杂的先天性门-系统分流关闭手术的有用工具。
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3D-printed model for surgical planning in congenital porto-systemic shunt: A case report

Introduction

Hepatobiliary surgery can be challenging due to the complex nature of variations in liver anatomy, particularly in small children. Congenital portosystemic shunts (CPS – Abernethy syndrome) are increasingly recognized with a range of clinical presentations and associated complications and can present anatomical challenges for operative shunt closure. Three-dimensional printing (3DP) has gained popularity due to its ability to produce accurate models with the specific anatomical characteristics for the individual patient. We used a 3DP model from original image sources for planning of surgical shunt closure in a child with CPS and for educating the family and surgical team preoperatively.

Case presentation

A 5-year-old male with autism and hyperammonemia of 80 μmol/L and was found to have an intrahepatic CPS. No tumors were seen within the liver. Physical examination was unremarkable. After treatment with Rifaximin to lower blood ammonia levels, his ability to concentrate and achieve milestones improved. Angiography with shunt occlusion showed an intrahepatic shunt between the left portal and the middle hepatic vein into the IVC. Intrahepatic portal branches were demonstrated with the implication that a one stage closure could be performed. A 3DP model was printed from the cross sectional imaging which allowed for more detailed planning of shunt ligation and to explain the surgical details to the parents. Surgical closure was performed with no complications.

Conclusion

3DP models can be a useful tool for planning complex congenital porto-systemic shunt closure surgery.
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
期刊最新文献
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