3D打印技术联合计算机辅助手术系统在下颌骨恶性肿瘤切除术后组织缺损修复中的应用
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摘要
目的:探究3D打印技术联合计算机辅助手术系统对下颌骨恶性肿瘤切除术后组织缺损修复的指导效果。方法:选取2016年3月-2019年3月在笔者医院颌面外科就诊的80例下颌骨恶性肿瘤切除术后修复患者,采用随机数字法分为常规组(40例)和实验组(40例)。常规组:给予常规颌骨重建手术进行修复;实验组:给予3D打印技术联合计算机辅助手术系统进行修复。观察并比较两组的疗效、手术情况、面颊肿胀程度、疼痛程度以及并发症发生情况。结果:实验组总有效率为95.00%,显著高于常规组的72.50%(P<0.05);实验组手术时间、术中出血量显著低于常规组(P<0.05);两组的面部肿胀程度无显著性差异(P>0.05);实验组无疼痛发生率显著高于常规组(P<0.05),中度疼痛、重度疼痛发生率及视觉模拟评分法(VAS)评分显著低于常规组(P<0.05),轻度疼痛发生率无显著性差异(P>0.05);实验组颈部血肿、淋巴瘘及涎瘘的发生率和常规组比较,均无显著性差异(P>0.05),但以上三种并发症合计发生率显著低于常规组(P<0.05)。结论:3D打印技术联合计算机辅助手术系统对下颌骨恶性肿瘤切除术后组织缺损修复具有较好的临床指导效果,可显著改善手术情况,减轻疼痛程度,降低并发症发生率,值得临床进一步推广。
Objective To explore the guiding effect of 3D printing technology combined with computer-assisted surgery system on tissue defect repair after resection of mandibular malignant tumor. Methods 80 patients with mandibular malignant tumor treated in our hospital between March 2016 and March 2019 were selected and randomly divided into the conventional group(40 cases) and the experimental group(40 cases). The conventional group was given conventional jaw reconstruction surgery for repair, while the experimental group was given 3D printing technology combined with computer-assisted surgery system for auxiliary repair. The curative effect, operation, cheek swelling, pain and complications were observed and compared in the two groups. Results The total number of effective cases in the experimental group was 38, and the total effective rate was 95.00%, significantly higher than 72.50% in the conventional group(P<0.05). The operation time and intraoperative blood loss in the experimental group were significantly lower than those in the conventional group(P<0.05). There was no significant difference in the degree of facial swelling between the two groups(P>0.05). The incidence of no pain in the experimental group was significantly higher than that in the conventional group(P<0.05), the incidence of moderate pain, severe pain and score of visual analogue scale(VAS) were significantly lower than those in the conventional group(P<0.05), and the incidence of mild pain had no significant difference(P>0.05). The incidence of cervical hematoma, lymphatic fistula and salivary fistula in the experimental group was not significantly different from that in the conventional group(P>0.05), but the total incidence of the above three complications was significantly lower than that in the conventional group(P<0.05). Conclusion 3 D printing technology combined with computer-assisted surgery system has a good clinical effect on tissue defect repair after resection of mandibular malignant tumor. It can significantly improve the operation situation, reduce the degree of pain and reduce the incidence of complications, and is worthy of further clinical research and promotion.
Objective To explore the guiding effect of 3D printing technology combined with computer-assisted surgery system on tissue defect repair after resection of mandibular malignant tumor. Methods 80 patients with mandibular malignant tumor treated in our hospital between March 2016 and March 2019 were selected and randomly divided into the conventional group(40 cases) and the experimental group(40 cases). The conventional group was given conventional jaw reconstruction surgery for repair, while the experimental group was given 3D printing technology combined with computer-assisted surgery system for auxiliary repair. The curative effect, operation, cheek swelling, pain and complications were observed and compared in the two groups. Results The total number of effective cases in the experimental group was 38, and the total effective rate was 95.00%, significantly higher than 72.50% in the conventional group(P<0.05). The operation time and intraoperative blood loss in the experimental group were significantly lower than those in the conventional group(P<0.05). There was no significant difference in the degree of facial swelling between the two groups(P>0.05). The incidence of no pain in the experimental group was significantly higher than that in the conventional group(P<0.05), the incidence of moderate pain, severe pain and score of visual analogue scale(VAS) were significantly lower than those in the conventional group(P<0.05), and the incidence of mild pain had no significant difference(P>0.05). The incidence of cervical hematoma, lymphatic fistula and salivary fistula in the experimental group was not significantly different from that in the conventional group(P>0.05), but the total incidence of the above three complications was significantly lower than that in the conventional group(P<0.05). Conclusion 3 D printing technology combined with computer-assisted surgery system has a good clinical effect on tissue defect repair after resection of mandibular malignant tumor. It can significantly improve the operation situation, reduce the degree of pain and reduce the incidence of complications, and is worthy of further clinical research and promotion.
引文
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[15]王静,赵林,刘美霞,等.计算机辅助手术系统联合3D打印在口腔颌面部缺损修复手术中的应用[J].青岛大学医学院学报,2016,52(6):639-641.
[16]李晋芸,黄文孝,陈杰,等.3D打印技术在晚期头颈恶性肿瘤手术治疗中的临床应用初探[J].中国耳鼻咽喉颅底外科杂志,2017,23(1):54-58.
[17]张纯妍,聂鑫.3D打印技术在颅颌面创伤应用的相关技术与发展趋势[J].创伤外科杂志,2018,20(1):67-71.
[18]屈振宇,王茜,赵岩,等.骨支持式3D打印导板在上颌骨LeFortⅠ型截骨术中的应用[J].华西口腔医学杂志,2018,36(1):60-65.
[2]克热木·阿巴司,赵莉,刘慧,等.游离组织皮瓣移植修复口腔颌面部恶性肿瘤切除术后组织缺损疗效及并发症观察[J].中国美容医学,2016,25(12):39-42.
[3]蒋阳,陈璐,苏琪琴.82例口腔颌面部恶性肿瘤患者术后护理[J].护理学报,2017,24(9):53-55.
[4]Zhang Y,Wen L,Zhang J,et al.Three-dimensional printing and computer navigation assisted hemipelvectomy for en bloc resection of osteochondroma:a case report[J]. Medicine(Baltimore),2017,96(12):6414.
[5]刘琳,李鸿波,刘洪臣.混合现实技术在口腔医学中的应用展望[J].口腔颌面修复学杂志, 2019,21(2):102-107.
[6]田忠奇,刘慧,胡露露,等.口腔颌面部恶性肿瘤患者术后术区感染危险因素分析[J].中国美容医学,2017,26(4):67-70.
[7]刘正武,王洁.血管化游离前臂皮瓣修复口腔颌面部肿瘤术后缺损6例临床分析[J].广西医科大学学报,2017,34(8):1227-1229.
[8]王雯文,白岫峰,胡一帆.80例口腔颌面肿瘤术后感染的影响因素分析及防治措施[J].实用癌症杂志,2017,32(10):1713-1715.
[9]杨晓林.口腔颌面部恶性肿瘤297例临床病理分析[J].中国现代医药杂志, 2016,18(2):64-66.
[10]吕春堂,张庆福.计算机辅助设计和3D打印技术与下颌骨缺损的个体化重建[J].口腔颌面外科杂志,2017,27(1):1-7.
[11]章文博,于尧,王洋,等.数字化外科技术在上颌骨缺损重建中的应用[J].北京大学学报(医学版),2017,49(1):1-5.
[12]刘华蔚,毕文婷,李永锋,等.数字化技术在颌骨缺损重建手术教学中的应用[J].中华老年口腔医学杂志,2018,16(4):239-241,250.
[13]王静,袁荣涛,董苻.计算机辅助手术系统与3D打印技术在口腔颌面部缺损修复重建中的应用[J].国际口腔医学杂志,2016,43(6):725-728.
[14]胡少伟,许彪,马文,等.3D打印技术在下颌角线性骨折中的应用[J].云南医药,2017, 38(1):19-20.
[15]王静,赵林,刘美霞,等.计算机辅助手术系统联合3D打印在口腔颌面部缺损修复手术中的应用[J].青岛大学医学院学报,2016,52(6):639-641.
[16]李晋芸,黄文孝,陈杰,等.3D打印技术在晚期头颈恶性肿瘤手术治疗中的临床应用初探[J].中国耳鼻咽喉颅底外科杂志,2017,23(1):54-58.
[17]张纯妍,聂鑫.3D打印技术在颅颌面创伤应用的相关技术与发展趋势[J].创伤外科杂志,2018,20(1):67-71.
[18]屈振宇,王茜,赵岩,等.骨支持式3D打印导板在上颌骨LeFortⅠ型截骨术中的应用[J].华西口腔医学杂志,2018,36(1):60-65.