【摘要】 目的 探讨3D打印技术在辅助治疗复杂B型主动脉夹层（SBAD）和腹主动脉瘤患者中的作用。方法 回顾性分析2022年1月至2024年1月绵阳四〇四医院收治64例复杂SBAD患者和64例腹主动脉瘤患者的临床资料。复杂SBAD患者中33例接受术前3D打印技术（观察组1）、31例采取术前常规检查（对照组1）；腹主动脉瘤患者32例接受术前3D打印技术辅助（观察组2）、32例采取术前常规检查（对照组2）。分析观察组1、观察组2患者经3D打印技术获得3D塑料模型不同阶段的解剖结构左右径（LR）、前后径（AP）变化；比较观察组1和对照组1、观察组2和对照组2患者围术期情况。结果 复杂SBAD患者，S2(STL模型)阶段的降主动脉膈肌水平LR均明显高于S1(CTA图)、S3（塑料模型）阶段（P<0.05）,S2阶段的降主动脉膈肌水平AP高于S3阶段（P<0.05）;S3阶段的头臂干LR均明显低于S1、S2阶段（P<0.05）,S3阶段的头臂干AP均明显高于S1、S2阶段（P<0.05）,S2阶段的头臂干AP高于S1阶段（P<0.05）;S3阶段的左颈总动脉LR均明显高于S1、S2阶段（P<0.05）,S2阶段的左颈总动脉LR高于S1阶段（P<0.05）,S3阶段的左颈总动脉AP低于S1阶段（P<0.05）;S3阶段的左锁骨下动脉LR和AP均明显高于S1、S2阶段（P<0.05）。腹主动脉瘤患者，S3阶段的瘤颈LR、AP均明显高于S1阶段（P<0.05）,S3阶段瘤颈AP明显高于S2阶段（P<0.05）;S3、S2阶段的瘤体LR、AP均明显高于S1阶段（P<0.05）,S3阶段的瘤体LR、AP均明显高于S2阶段（P<0.05）;S3、S2阶段的腹主动脉分叉LR均明显高于S1阶段（P<0.05）,S3阶段的腹主动脉分叉LR均明显高于S2阶段（P<0.05）,S3阶段的腹主动脉分叉AP均明显低于S1阶段（P<0.05）;S3阶段的左髂总动脉AP均明显低于S1阶段（P<0.05）。观察组1复杂SBAD患者的手术时间、血管腔内操作时间、住院时间均明显短于对照组1(P<0.05)，术中出血量、对比剂用量均低于对照组1(P<0.05)。观察组2腹主动脉瘤患者的手术时间、血管腔内操作时间、住院时间均明显短于对照组2(P<0.05)，术中出血量、对比剂用量均低于对照组2(P<0.05)。复杂SBAD患者、腹主动脉瘤患者在术后6个月复查时均未出现内漏、支架移位情况。结论 3D打印技术有助于精准测量复杂SBAD、腹主动脉瘤患者病变部位解剖结构，术前3D塑料模型预演手术可缩短手术时间、住院时间和减少对比剂用量，且不影响手术疗效。更多还原

【Abstract】 Objective To discuss the application of 3D printing technology in the adjuvant treatment of complex Stanford type B aortic dissection(SBAD)and abdominal aortic aneurysm.Methods The clinical data of 64 patients with complex SBAD and 64 patients with abdominal aortic aneurysm,who were admitted to the Mianyang No.404 Hospital of China from January 2022 to January 2024,were retrospectively analyzed.Of the 64 patients with complex SBAD,33 received preoperative 3D printing adjuvant treatment(observation group Ⅰ)and 31 received preoperative routine examination(control group Ⅰ)．Of the 64 patients with abdominal aortic aneurysm,32 received preoperative 3D printing adjuvant treatment(observation group Ⅱ)and 32 received preoperative routine examination(control groupⅡ)．The changes in left-right diameter(LR)and anterior-posterior diameter(AP)of anatomical structure in observation group Ⅰ and observation group Ⅱ were analyzed.The perioperative situations were compared between observation groupⅠand control groupⅠ,as well as between observation groupⅡ and control groupⅡ．Results In patients with complex SBAD,LR of descending aorta diaphragm in S2(STL model)was significantly higher than that in S1(CTA image)and S3(plastic model,P<0.05),and AP of descending aorta diaphragm in S2 was higher than that in S3(P<0.05).LR of brachiocephalic trunk in S3 was significantly lower than that in S1 and S2(P<0.05),AP of brachiocephalic trunk in S3stage was significantly higher than that in S1 and S2(P<0.05),and AP of brachiocephalic trunk in S2was higher than that in S1(P<0.05).LR of left common carotid artery in S3 was significantly higher than that in S1 and S2(P<0.05),LR of left common carotid artery in S2 was higher than that in S1(P<0.05),and AP of left common carotid artery in S3 was lower than that in S1(P<0.05).LR and AP of left subclavian artery in S3 were significantly higher than those in S1 and S2(P<0.05).In patients with abdominal aortic aneurysm,LR and AP of tumor neck in S3 were significantly higher than those in S1(P<0.05),and AP of aneurysm neck in S3 was significantly higher than that in S2(P<0.05).LR and AP of aneurysm in S3 and S2 were significantly higher than those in S1(P<0.05),and LR and AP of aneurysm in S3 were significantly higher than those in S2(P <0.05).LR of abdominal aortic bifurcation in S3 and S2 was significantly higher than that in S1(P<0.05),LR of abdominal aortic bifurcation in S3 was significantly higher than that in S2(P<0.05),and AP of abdominal aortic bifurcation in S3 was significantly lower than that in S1(P<0.05).AP of left common iliac artery in S3was significantly lower than that in S1(P<0.05).In the observation group Ⅰ,the operation time,endovascular operation time and length of hospital stay were significantly shorter than those in the control groupⅠ （P<0.05）,and the intraoperative blood loss and used dosage of contrast agent were lower than those in the control group Ⅰ （P<0.05）.In observation group Ⅱ,the operation time,endovascular operation time and length of hospital stay were significantly shorter than those in the control group Ⅱ（P<0.05）,and the intraoperative blood loss and used dosage of contrast agent were lower than those in the control groupⅡ （P<0.05）.In patients with complex SBAD or abdominal aortic aneurysm,there was no internal leakage or stent displacement at 6 months after surgery.Conclusion Adjuvant treatment with3D printing technology is helpful for improving anatomical structure measurement of lesion sites in patients with complex SBAD and abdominal aortic aneurysm.Preoperative 3D plastic model preview surgery is helpful for shortening the operation time and length of hospital stay and reducing the used dosage of contrast agent without affecting surgical treatment effect.更多还原