CN107837130A - It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method - Google Patents
It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method Download PDFInfo
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- CN107837130A CN107837130A CN201711214799.4A CN201711214799A CN107837130A CN 107837130 A CN107837130 A CN 107837130A CN 201711214799 A CN201711214799 A CN 201711214799A CN 107837130 A CN107837130 A CN 107837130A
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- overlay film
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- aorta
- aortic arch
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B33—ADDITIVE MANUFACTURING TECHNOLOGY
- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
- B33Y10/00—Processes of additive manufacturing
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B33—ADDITIVE MANUFACTURING TECHNOLOGY
- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
- B33Y50/00—Data acquisition or data processing for additive manufacturing
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B33—ADDITIVE MANUFACTURING TECHNOLOGY
- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
- B33Y80/00—Products made by additive manufacturing
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
- A61F2/06—Blood vessels
- A61F2/07—Stent-grafts
- A61F2002/072—Encapsulated stents, e.g. wire or whole stent embedded in lining
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2240/00—Manufacturing or designing of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2240/001—Designing or manufacturing processes
- A61F2240/002—Designing or making customized prostheses
Abstract
The invention belongs to biomedical engineering field, and in particular to it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method, comprise the following steps：3D printing technique 1 is utilized by the CT view data of patient:1 replicates patient's lesion arch of aorta；Vessel branch opening, position and the size of the arch of aorta are marked on transparent membrane using sustainer 3D models；Overlay film main support is taken, is covered using labeled transparent sheet on overlay film main support, and the perforate successively on branch vessel correspondence position；The small overlay film frame that diameter matches with support opening diameter is chosen, each tapping is sewn in respectively, produces the individuation overlay film frame matched completely with the patient.The present invention can reach the purpose of precisely treatment Stanford A type aortic arch interlayers, realize personalized treatment, the generation for save operating time, reducing intraoperative hemorrhage, greatly reduce postoperative complications.
Description
Technical field
The invention belongs to biomedical engineering field, and in particular to a kind of quick prepare is used to treat aortic arch interlayer
Art in individuation overlay film frame method.
Background technology
Dissection of aorta (aortic dissection, AD) is rare and serious cardiovascular emergency and severe disease, is characterized in sending out
Sick disease progression is rapid suddenly, and acute stage case fatality rate is high, untreated Standford A type aortic arch interlayer case fatality rate
Up to 80%.Because aortic dissection form is changeable, branch vessel is numerous, and disease also has complicated sexual factor in itself, therefore controls
Many difficulties in treatment be present.
Aortic arch replacement is to treat the important component that Standford A type aortic archs interlayer is performed the operation, surgery
The purpose for the treatment of, it is the arch of aorta and its branch vessel that lesion is replaced with artificial blood vessel, so as to ensure that systemic blood is supplied.
Classics operation is that overlay film frame is placed in descending aorta, with the full Aortic arch replacement of Four branches aortic graft row, artificial blood vessel
Distal end coincide with each branch vessel on the arch of aorta respectively with descending aorta proximal anastomosis, each branch.Traditional operation bleeding
It is more, to appear difficult, complication more.The Cardiopulmonary Bypass of Deep Hypothermia Circulatory Arrest is the necessary bar for carrying out full Aortic arch replacement
Part, the operation are related to the subjects such as anesthesia, CT, echocardiogram, operating room, extracorporal circulatory system.In general Grade A hospital is difficult to carry out,
It is the significant operation of general hospital.Operation is also very complicated in itself, and what is sutured on the aorta wall of acute inflammation stage is outer
Section's technical requirements are high, and difficulty exceeds well over heart transplant.
Then there is the new skill of three branching type arch of aorta overlay film frames treatment Stanford A type aortic arch interlayers
Art.Overlay film frame in art, it is the artificial blood vessel that a kind of nickel-titanium memory metallic support is coated to terylene, for the surgical intervention arch of aorta
Portion's interlayer.Three branching type arch of aorta overlay film frames are by the arch of aorta and distal end descending aorta overlay film frame blood vessel and three head arm
Sewing is integrated and compresses the artificial blood vessel of binding blood vessel covered stent in advance, is opened along aorta ascendens longitudinal incision to innominate artery
At mouth 1.5cm, each branch vessel opening of the exposure arch of aorta.Each branch of overlay film frame that design has bundled is sequentially placed into drop master
Artery, left subclavian artery (LSA), left common carotid artery (LCCA), truncus brachiocephalicus artery (BT) Endovascular, and support is discharged successively
Trunk and three branches, and check that trunk stented vessel and three branch stent blood vessels have distortionless and given a discount.To a certain extent
Simplify the treatment of aortic arch interlayer.Because the arch of aorta and the branch vessel of BT, LCCA, LSA tri- of each patient are dissected
Relation, size respectively have differences, and the support is applied being commercialized finished product, and three branch stent positions be present fixes, Wu Fashi
With each case so that the support can not match completely with the branch vessel of BT, LCCA, LSA tri- completely, easily occur remaining
Leakage, false chamber do not close, stent migration and come off, and cause new interlayer to occur, or even increase operating difficulty.It can not even more tackle out
The now situation of bow portion anatomical variation.
In order to avoid the above-mentioned three branching types arch of aorta overlay film frame operation relevant risk and improve its deficiency, occur
Individuation sectional shelf-unit technology treats aortic arch interlayer.It is using small rack weight in single branch's overlay film frame and branch vessel
Aortic arch is built, i.e. individuation combination overlay film frame rebuilds aortic arch surgery, selection of the technology in art formula and indication
On it is relatively more flexible, can apply to almost all kinds of aortic arch interlayer patient.But operation needs opening thoracic cavity to exist
Sustainer and branch vessel are detected, after cutting sustainer, the relative position of ability measurement branches openings in blood vessels, small branch's overlay film
The suture of support and main overlay film frame is carried out in aorta lumen, is added operating time and difficulty to a certain extent, is made
Obtain operation risk increase.
Research shows that the aberration rate of the arch of aorta branch of the mankind is 20% or so, and the frequent species of variation is up to nine kinds
Type.In addition, branch vessel internal diameter size, angle and branch openings position are associated with sex, age, blood pressure etc., individual difference
It is different big.The lesion of aortic arch interlayer is extremely complex, the scope that interlayer involves, and whether there is cut, the position of cut, to combination
The selection of support has important directive significance.
The purpose of the present invention, it is exactly by 3D printing technique, measures body in the preoperative to different aortic arch interlayer patients and determine
Individual overlay film frame processed, so as to which the intervention theory of " inner cavity insulation " is incorporated into full Aortic arch replacement operation.Greatly
It is big to simplify operation technique, shorten operating time, reduce the generation of complication, promoted beneficial to basic hospital.
The problem of existing for above-mentioned several modus operandis, we use 3D printing technique Computer Aided Design individuation overlay film branch
Stanford A type aortic arch interlayers are precisely treated in frame application.I.e. using individuation overlay film frame rebuild the arch of aorta and its
Bend part branch vessel.
The content of the invention
Present invention aim to address Standford A type aortic arch interlayers operation technique is difficult, operation is complicated, consumption
Duration, wound are big, bleeding is more, complication is more, costly, basic hospital can not be promoted the problems such as, there is provided a kind of quick to prepare
The method of individuation overlay film frame in art for treating aortic arch interlayer.
The present invention is achieved by the following technical solutions：
It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method, it is including following
Step：
(1) 3D printing technique 1 is utilized by the CT view data of patient:1 replicates patient's lesion arch of aorta；
(2) using aortic arch 3D models marked on transparent membrane the vessel branch opening of the arch of aorta, position and
Size；
(3) overlay film main support is taken, is covered using labeled transparent membrane on overlay film main support, and it is corresponding in branch vessel
Perforate successively on position, obtain the overlay film main support of perforate；
(4) the small overlay film frame that diameter matches with support opening diameter is chosen, is sewn in each tapping respectively, and ensure seam
Zhi Hou branches trend moves towards identical with actual vessel, produces the individuation overlay film frame matched completely with the patient.
Preferably, step (1) is described utilizes 3D printing technique 1 by the CT view data of patient:1 replicates patient lesion master
The arch of aorta comprises the following steps：
(11) patient sustainer bow position scan data is obtained using helical CT scanners；
(12) scan data is subjected to aortic arch interlayer three-dimensional reconstruction；
(13) the aortic arch model data Input Software handled well is subjected to section plus support processing；
(14) data file after adding support processing that will cut into slices imports 3D printer printing.
Preferably, step (2) vessel branch for marking the arch of aorta on transparent membrane using sustainer 3D models
Opening, position and size comprise the following steps：
(21) the aortic arch model printed is removed into aortic arch vessel branch, exposes branch in sustainer
Bow opening；
(22) transparent membrane is cut into suitable size, is covered at branch openings, on transparent membrane in corresponding opening
The big mark such as do in position；
(23) transparent membrane at mark position is removed, obtains open amount, position and size with aortic arch model
The transparent membrane that matches of opening.
Preferably, the material of the transparent membrane is polypropylene.
Preferably, the diameter of step (3) described perforate is more than 10~20% of aperture on transparent membrane.
The beneficial effects of the present invention are：
It is existing will the branching type arch of aorta overlay film frame of commercialization three treatment Stanford A types aortic archs folder
Layer, because it is not 1 according to each patient:The design of 1 3D printing model, so individuation demand can not be met, branch be present
Frame and the fitting of sustainer inwall are bad, cause the appearance of postoperative internal fistula, and false chamber at a specified future date does not close, the problems such as stent migration.Due to
The morbidity of this disease is more anxious, temporarily very time-consuming from the support of producer's purchase suitable dimension, some patient in waiting process,
Generation aorta rupture, causes death.
Stanford A type aortic arch interlayers are treated using individuation sectional shelf-unit, although accommodation is cleverer
It is living, according to lesion type, independent assortment support, can easily tackle the situation of aortic arch branch variation, but due to be
After sustainer and branch vessel are detected in opening thoracic cavity in operation, the relative position of each branch stent could be designed, then sutured
Each branch stent is combined, adds operating time to a certain extent so that operation risk increase.Due to being grasped in intracavitary
Make, the suture to branch stent has great difficulty.
And the present invention prints 1 by 3D printing technique:1 arch of aorta and branch vessel model, precisely copies master
Branch vessel quantity, size and the aperture position in arch of aorta portion, set according to the aortic arch vascular pattern that Different Individual is exclusive
Individuation overlay film frame is counted, arch of aorta relevant position is implanted into through aorta ascendens otch, can solve overlay film frame and blood vessel not
The problem of matching, can more tackle calmly aortic arch branch variation situation, shorten operating time, this operation it is time-consuming average
At 4.5 hours.And first two operation method takes 6-8 hours, even more long.Traditional full bow support adds support " trunk " operation consumption
When about 10-12 hours, need delayed sternal closure what is more.This technical method combines the branch's arch of aorta overlay film of commercialization finished product three
The advantage of support and individuation overlay film frame, without the free arch of aorta and each branch vessel, cut in art from aorta ascendens distal end
Open, individuation arch of aorta overlay film frame is inserted under direct-view, simplify the operation technique of arch of aorta drop portion and head arm blood vessel, it is main
Arch of aorta portion previous anastomotic is changed into one from multiple, greatly shortens the Deep Hypothermia Circulatory Arrest time, reduces wound, reduces bleeding, shortens
Operating time so that various severe complications are greatly decreased, and due to not free bow portion and head arm blood vessel, avoid damage larynx and return god
Through, and be even more to have unique advantage for the complicated dissection of aorta of bow portion situation, such as the variation of head arm branch vessel：Four
Branch vessel reaches precision treatment from the arch of aorta, or two branch vessels from the arch of aorta entirely.
Brief description of the drawings
Fig. 1 be the present invention it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method
Flow chart.
Fig. 2 is that individuation three branch's overlay film frame prepares schematic diagram in embodiment 1.
Fig. 3 is that individuation two branch's overlay film frame prepares schematic diagram in embodiment 2.
Fig. 4 is that individuation four branch's overlay film frame prepares schematic diagram in embodiment 3.
Fig. 5 is that individuation three branch's overlay film frame prepares schematic diagram in embodiment 4.
1. sustainer 3D models in figure, 2. remove the sustainer 3D models of branch, 3. transparent membrane, 4. mark the saturating of perforate
The main nickel-titanium memory coating metal terylene support of bright diaphragm, 5. big nickel-titanium memory coating metal terylene support, 6. perforate is 7. small
Branch's nickel-titanium memory coating metal terylene support, the 8. nickel-titanium memory coating metal terylene support with branch, 9. aortic blood
Manage, 10. the cross-section upper part in bow portion,The cross-section upper part inner face in bow portion is seen.
Embodiment
To be best understood from the present invention, with reference to embodiment and accompanying drawing, the invention will be further described, following examples
Only it is that the present invention will be described rather than it is limited.
Embodiment 1
It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method flow such as Fig. 1
It is shown：
1. Model Reconstruction
Equipment uses the multi-slice Spiral CT instrument of Discovery CT 750HD (GE companies, the U.S.) 64.Patient makes even sleeping
Position, holds one's breath, first obtains non-reinforcing CT sequences (0.625mm thickness), 22G venous indwelling pin puncture ulnar veins, through multi-layer spiral CT
Scanner carries high pressure injector injection Iohexol (Omnipaque, the I/mL of 350mg containing iodine) 100mL, monitors medicine peak value, arrives
Postpone 6~8s after peaking.Target area Shang Qijing roots, under export in dicom format to pubic symphysis, scan data, and lead
The softwares of people Mimics 19.0 carry out aortic arch interlayer three-dimensional reconstruction, and extraction scope includes whole sustainer part, model table
The smooth modification in face, and with STL form reduced models.After STL models lead the progress model surface modification of the softwares of people 3-matic 11.0,
Model outer surface shell adding thickness 2mm, extract hollow blood vessel thickness 2mm aortic arch sandwich mould.By what is handled well
Sustainer model STL data input meditoolcreate softwares carry out section plus support processing, generate medtjob2 files, so
After import the file into Stereolithography SLA (stereolithography) 3D printer (Pan Gu 2.1) carry out model printing,
Printed material is soft liquid photosensitive resin after selecting Stereolithography, completes aortic arch sandwich mould.
2. model evaluation
3D printing model is assessed：(1) contrast 3D models and thoracoabdominal aorta CTA three-dimensional reconstruction results measured value whether
Unanimously, whole observation sustainer cut and important branch position；(2) understand aortic arch form, determine each branch vessel
Aperture position；(3) true chamber size is simulated, (the more corresponding artery diameter of overlay film frame external diameter is big by 10% 1 from stent diameter for assessment
15%)；(4) assessment of stent release after with the arch of aorta and each branch vessel appropriateness degree.
3. the design of the branch's overlay film frame of individuation three
(1) the big vascular pattern printed is removed into the vessel branch of aortic arch three, exposes three branches in sustainer
Bow opening.(2) it is that 0.2mm polypropylene sheets are cut into suitable size by thickness, is covered at three branch openings, it is thin in polypropylene
The big mark such as do on piece at corresponding opening position, and remove mark position thin slice, obtain openings of sizes and position with blood vessel mould
The polypropylene sheet that opening in type matches.(3) it is the polypropylene sheet Low-temperature Plasma Sterilization prepared is standby.(4) release
Overlay film main support (production of Beijing Yu Hengjia Science and Technology Ltd.s) is decontroled, the diaphragm prepared is placed in mount proximal end, is attached at
Rack outer surface, and rack surface mark there emerged a aperture position, with fulguration knife on overlay film frame perforate successively, opening diameter
More than the branch openings diameter about 15% of model three.(5) the small overlay film frame that diameter matches with support opening diameter is chosen, respectively
Sewing and each tapping, positive three branches trend is protected during sewing and is same as actual vessel trend.(6) three branches that will have been sewed
Individuation overlay film frame bundlees standby (Fig. 2) again.
4. operating procedure
Chest exposure aorta ascendens and aortic arch are opened, without each branch vessel of dissociating, row right axillary artery intubation, through epicoele
Vein, atrium dextrum place superior and inferior vena cave drainage tube and establish cardiopulmonary bypass.Clamping of aorta epimere after turn of tidal stream cooling, cuts
Sustainer, irrigate HTK liquid to cardiac arrest through left and right coronary ostium and be satisfied with.Lesion inner membrance is cut off, removes false intracavitary blood clotting
Block, row Bentall arts, David arts or Wheat arts etc. are determined according to the expansion of aortic sinus portion and aortic valve situation.Cooling
To 18 DEG C, stop circulating, right axillary artery selective cerebral perfusion, open aortic occlusion clamp, along aorta ascendens longitudinal incision to unknown
At arterial ostium 1.5cm, each branch vessel opening of exposure aortic arch.Each point of the individuation overlay film frame bundled will be designed
Branch is sequentially placed into descending aorta, LSA, LCCA, BT Endovascular, and discharges support trunk and three branches successively, and checks trunk
Stented vessel and three branch stent blood vessels have distortionless and given a discount.About 40 DEG C of salt solution is injected in three branch stents, makes it
Plastotype and expansion support.By three branch stent near-ends and artificial blood vessel or valved conduit distal end or risen actively with 4-0prolene lines
Arteries and veins coincide, and open after sustainer exhaust, progressively slow rewarming is to 37 DEG C, phased out cardiopulmonary bypass after auxiliary circulation, slow fish
In protamine and heparin, upper and lower cannula cavity and axillary artery intubation is pulled out, chest is closed in hemostasis.
Embodiment 2
It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method flow such as Fig. 1
It is shown：
1. Model Reconstruction
Equipment uses the multi-slice Spiral CT instrument of Discovery CT 750HD (GE companies, the U.S.) 64.Patient makes even sleeping
Position, holds one's breath, first obtains non-reinforcing CT sequences (0.625mm thickness), 22G venous indwelling pin puncture ulnar veins, through multi-layer spiral CT
Scanner carries high pressure injector injection Iohexol (Omnipaque, the I/mL of 350mg containing iodine) 100mL, monitors medicine peak value, arrives
Postpone 6~8s after peaking.Target area Shang Qijing roots, under export in dicom format to pubic symphysis, scan data, and lead
The softwares of people Mimics 19.0 carry out aortic arch interlayer three-dimensional reconstruction, and extraction scope includes whole sustainer part, model table
The smooth modification in face, and with STL form reduced models.After STL models lead the progress model surface modification of the softwares of people 3-matic 11.0,
Model outer surface shell adding thickness 2mm, extract hollow blood vessel thickness 2mm aortic arch sandwich mould.By what is handled well
Sustainer model STL data input meditoolcreate softwares carry out section plus support processing, generate medtjob2 files, so
After import the file into Stereolithography SLA (stereolithography) 3D printer (Pan Gu 2.1) carry out model printing,
Printed material is soft liquid photosensitive resin after selecting Stereolithography, completes aortic arch sandwich mould.
2. model evaluation
3D printing model is assessed：(1) contrast 3D models and thoracoabdominal aorta CTA three-dimensional reconstruction results measured value whether
Unanimously, whole observation sustainer cut and important branch position；(2) understand arch of aorta form, determine opening for each branch vessel
Mouth position；(3) true chamber size is simulated, (the more corresponding artery diameter of overlay film frame external diameter is big by 10% 1 from stent diameter for assessment
15%)；(4) assessment of stent release after with the arch of aorta and each branch vessel appropriateness degree.
3. the design of the branch's overlay film frame of individuation two
(1) the big vascular pattern printed is removed into the vessel branch of aortic arch two, exposes two branches in sustainer
Bow opening.(2) it is that 0.2mm polypropylene sheets are cut into suitable size by thickness, is covered at two branch openings, it is thin in polypropylene
The big mark such as do on piece at corresponding opening position, and remove mark position thin slice, obtain openings of sizes and position with blood vessel mould
The polypropylene sheet that opening in type matches.(3) it is the polypropylene sheet Low-temperature Plasma Sterilization prepared is standby.(4) release
Overlay film main support (production of Beijing Yu Hengjia Science and Technology Ltd.s) is decontroled, the diaphragm prepared is placed in mount proximal end, is attached at
Rack outer surface, and rack surface mark there emerged a aperture position, with fulguration knife on overlay film frame perforate successively, opening diameter
More than the branch openings diameter about 10% of model two.(5) the small overlay film frame that diameter matches with support opening diameter is chosen, respectively
Sew and ensure that two branches trend is same as actual vessel trend during each tapping, sewing.(6) two branches that will have been sewed
Individuation overlay film frame bundlees standby (Fig. 3) again.
4. operating procedure
Chest exposure aorta ascendens and aortic arch are opened, without each branch vessel of dissociating, row right axillary artery intubation, through epicoele
Vein, atrium dextrum place superior and inferior vena cave drainage tube and establish cardiopulmonary bypass.Clamping of aorta epimere after turn of tidal stream cooling, cuts
Sustainer, irrigate HTK liquid to cardiac arrest through left and right coronary ostium and be satisfied with.Lesion inner membrance is cut off, removes false intracavitary blood clotting
Block, row Bentall arts, David arts or Wheat arts etc. are determined according to the expansion of aortic sinus portion and aortic valve situation.Cooling
To 18 DEG C, stop circulating, right axillary artery selective cerebral perfusion, open aortic occlusion clamp, along aorta ascendens longitudinal incision to unknown
At arterial ostium 1.5cm, each branch vessel opening of the exposure arch of aorta.Each branch of individuation sectional shelf-unit bundled will be designed
Descending aorta, LSA, LCCA, BT Endovascular are sequentially placed into, and discharges support trunk and two branches successively, and checks trunk branch
Frame blood vessel and two branch stent blood vessels have distortionless and given a discount.About 40 DEG C of salt solution is injected in two branch stents, makes its modeling
Type and expansion support.With 4-0prolene lines by two branch stent near-ends and artificial blood vessel or valved conduit distal end or aorta ascendens
It coincide, open after sustainer exhaust, progressively slow rewarming is to 37 DEG C, phased out cardiopulmonary bypass after auxiliary circulation, slow milt
In albumen and heparin, upper and lower cannula cavity and axillary artery intubation is pulled out, chest is closed in hemostasis.
Embodiment 3
It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method flow such as Fig. 1
It is shown：
1. Model Reconstruction
Equipment uses the multi-slice Spiral CT instrument of Discovery CT 750HD (GE companies, the U.S.) 64.Patient makes even sleeping
Position, holds one's breath, first obtains non-reinforcing CT sequences (0.625mm thickness), 22G venous indwelling pin puncture ulnar veins, through multi-layer spiral CT
Scanner carries high pressure injector injection Iohexol (Omnipaque, the I/mL of 350mg containing iodine) 100mL, monitors medicine peak value, arrives
Postpone 6~8s after peaking.Target area Shang Qijing roots, under export in dicom format to pubic symphysis, scan data, and lead
The softwares of people Mimics 19.0 carry out aortic arch interlayer three-dimensional reconstruction, and extraction scope includes whole sustainer part, model table
The smooth modification in face, and with STL form reduced models.After STL models lead the progress model surface modification of the softwares of people 3-matic 11.0,
Model outer surface shell adding thickness 2mm, extract hollow blood vessel thickness 2mm aortic arch sandwich mould.By what is handled well
Sustainer model STL data input meditoolcreate softwares carry out section plus support processing, generate medtjob2 files, so
After import the file into Stereolithography SLA (stereolithography) 3D printer (Pan Gu 2.1) carry out model printing,
Printed material is soft liquid photosensitive resin after selecting Stereolithography, completes aortic arch sandwich mould.
2. model evaluation
3D printing model is assessed：(1) contrast 3D models and thoracoabdominal aorta CTA three-dimensional reconstruction results measured value whether
Unanimously, whole observation sustainer cut and important branch position；(2) understand arch of aorta form, determine opening for each branch vessel
Mouth position；(3) true chamber size is simulated, (the more corresponding artery diameter of overlay film frame external diameter is big by 10% 1 from stent diameter for assessment
15%)；(4) assessment of stent release after with the arch of aorta and each branch vessel appropriateness degree.
3. the design of the branch's overlay film frame of individuation four
(1) the big vascular pattern printed is removed into the vessel branch of aortic arch four, exposes four branches in sustainer
Bow opening.(2) it is that 0.2mm polypropylene sheets are cut into suitable size by thickness, is covered at four branch openings, it is thin in polypropylene
The big mark such as do on piece at corresponding opening position, and remove mark position thin slice, obtain openings of sizes and position with blood vessel mould
The polypropylene sheet that opening in type matches.(3) it is the polypropylene sheet Low-temperature Plasma Sterilization prepared is standby.(4) release
Overlay film main support (production of Beijing Yu Hengjia Science and Technology Ltd.s) is decontroled, the diaphragm prepared is placed in mount proximal end, is attached at
Rack outer surface, and rack surface mark there emerged a aperture position, with fulguration knife on overlay film frame perforate successively, opening diameter
More than the branch openings diameter about 10% of model four.(5) the small overlay film frame that diameter matches with support opening diameter is chosen, respectively
Sew and ensure that four branches trend is same as actual vessel trend during each tapping, sewing.(6) four branches that will have been sewed
Individuation overlay film frame pipe bundlees standby (Fig. 4) again.
4. operating procedure
Chest exposure aorta ascendens and aortic arch are opened, without each branch vessel of dissociating, row right axillary artery intubation, through epicoele
Vein, atrium dextrum place superior and inferior vena cave drainage tube and establish cardiopulmonary bypass.Clamping of aorta epimere after turn of tidal stream cooling, cuts
Sustainer, irrigate HTK liquid to cardiac arrest through left and right coronary ostium and be satisfied with.Lesion inner membrance is cut off, removes false intracavitary blood clotting
Block, row Bentall arts, David arts or Wheat arts etc. are determined according to the expansion of aortic sinus portion and aortic valve situation.Cooling
To 18 DEG C, stop circulating, right axillary artery selective cerebral perfusion, open aortic occlusion clamp, along aorta ascendens longitudinal incision to unknown
At arterial ostium 1.5cm, each branch vessel opening of the exposure arch of aorta.Each branch of individuation overlay film frame bundled will be designed
Descending aorta, LSA, LCCA, BT Endovascular are sequentially placed into, and discharges support trunk and four branches successively, and checks trunk branch
Frame blood vessel and four branch stent blood vessels have distortionless and given a discount.About 40 DEG C of salt solution is injected in four branch stents, makes its modeling
Type and expansion support.With 4-0prolene lines by four branch stent near-ends and artificial blood vessel or valved conduit distal end or aorta ascendens
It coincide, open after sustainer exhaust, progressively slow rewarming is to 37 DEG C, phased out cardiopulmonary bypass after auxiliary circulation, slow milt
In albumen and heparin, upper and lower cannula cavity and axillary artery intubation is pulled out, chest is closed in hemostasis.
Embodiment 4
It is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method flow such as Fig. 1
It is shown：
1. Model Reconstruction
Equipment uses the multi-slice Spiral CT instrument of Discovery CT 750HD (GE companies, the U.S.) 64.Patient makes even sleeping
Position, holds one's breath, first obtains non-reinforcing CT sequences (0.625mm thickness), 22G venous indwelling pin puncture ulnar veins, through multi-layer spiral CT
Scanner carries high pressure injector injection Iohexol (Omnipaque, the I/mL of 350mg containing iodine) 100mL, monitors medicine peak value, arrives
Postpone 6~8s after peaking.Target area Shang Qijing roots, under export in dicom format to pubic symphysis, scan data, and lead
The softwares of people Mimics 19.0 carry out aortic arch interlayer three-dimensional reconstruction, and extraction scope includes whole sustainer part, model table
The smooth modification in face, and with STL form reduced models.After STL models lead the progress model surface modification of the softwares of people 3-matic 11.0,
Model outer surface shell adding thickness 2mm, extract hollow blood vessel thickness 2mm aortic arch sandwich mould.By what is handled well
Sustainer model STL data input meditoolcreate softwares carry out section plus support processing, generate medtjob2 files, so
After import the file into Stereolithography SLA (stereolithography) 3D printer (Pan Gu 2.1) carry out model printing,
Printed material is soft liquid photosensitive resin after selecting Stereolithography, completes aortic arch sandwich mould.
2. model evaluation
3D printing model is assessed：(1) contrast 3D models and thoracoabdominal aorta CTA three-dimensional reconstruction results measured value whether
Unanimously, whole observation sustainer cut and important branch position；(2) understand arch of aorta form, determine opening for each branch vessel
Mouth position；(3) true chamber size is simulated, (the more corresponding artery diameter of overlay film frame external diameter is big by 10% 1 from stent diameter for assessment
15%)；(4) assessment of stent release after with the arch of aorta and each branch vessel appropriateness degree.
3. the design of the branch's overlay film frame of individuation three
(1) sustainer model bow portion cross section is splitted, by model inwall, positions each branch openings and determine that opening is big
It is small.(2) it is that 0.2mm polypropylene sheets are cut into suitable size by thickness, is covered at three branch openings, in polypropylene sheet
The big mark such as do at corresponding opening position, and remove mark position thin slice, obtain openings of sizes and position with vascular pattern
The polypropylene sheet that matches of opening.(3) it is the polypropylene sheet Low-temperature Plasma Sterilization prepared is standby.(4) discharge
Overlay film main support (production of Beijing Yu Hengjia Science and Technology Ltd.s), is placed in mount proximal end by the diaphragm prepared, is attached at support
Outer surface, and there emerged a aperture position in rack surface mark, with fulguration knife, perforate successively, opening diameter are more than on overlay film frame
The branch openings diameter about 15% of model three.(5) the small overlay film frame that diameter matches with support opening diameter is chosen, is sewed respectively
With each tapping, positive three branches trend is protected during sewing and is same as actual vessel trend.(6) by three branches sewed individual
Change overlay film frame to bundle again standby (Fig. 1).
4. operating procedure
Chest exposure aorta ascendens and aortic arch are opened, without each branch vessel of dissociating, row right axillary artery intubation, through epicoele
Vein, atrium dextrum place superior and inferior vena cave drainage tube and establish cardiopulmonary bypass.Clamping of aorta epimere after turn of tidal stream cooling, cuts
Sustainer, irrigate HTK liquid to cardiac arrest through left and right coronary ostium and be satisfied with.Lesion inner membrance is cut off, removes false intracavitary blood clotting
Block, row Bentall arts, David arts or Wheat arts etc. are determined according to the expansion of aortic sinus portion and aortic valve situation.Cooling
To 18 DEG C, stop circulating, right axillary artery selective cerebral perfusion, open aortic occlusion clamp, along aorta ascendens longitudinal incision to unknown
At arterial ostium 1.5cm, each branch vessel opening of the exposure arch of aorta.Each branch of individuation overlay film frame bundled will be designed
Descending aorta, LSA, LCCA, BT Endovascular are sequentially placed into, and discharges support trunk and three branches successively, and checks trunk branch
Frame blood vessel and three branch stent blood vessels have distortionless and given a discount.About 40 DEG C of salt solution is injected in three branch stents, makes its modeling
Type and expansion support.With 4-0prolene lines by three branch stent near-ends and artificial blood vessel or valved conduit distal end or aorta ascendens
It coincide, open after sustainer exhaust, progressively slow rewarming is to 37 DEG C, phased out cardiopulmonary bypass after auxiliary circulation, slow milt
In albumen and heparin, upper and lower cannula cavity and axillary artery intubation is pulled out, chest is closed in hemostasis.
Comparative example mounts the treatment of people's art using full bow displacement+trunk branch
Place intrusion pipe through right axillary artery and place superior and inferior vena cave drainage tube through atrium dextrum and establish extracorporal circulatory system.Favourable turn
And less than 32 DEG C are cooled to, clamping of aorta, contain after cutting aorta ascendens through left and right coronary ostium 25 DEG C of high potassium of perfusion
Blood cardioplegic solution, irrigate 1 time within every 30 minutes.Continue to cool, while the displacement of row aorta ascendens, Bentall arts or David arts.
Nasopharyngeal temperature is down to 18 DEG C, stops circulating, and innominate artery, left common carotid artery and left subclavian artery is blocked successively, with 10mlkg﹣ 1·min﹣ 1Row brain selective perfusion, head keep low level and added to use ice bag.The arch of aorta is cut, in left subclavian artery opening
With remote cross-section sustainer.Overlay film frame (production of Shanghai minimally invasive medical Instruments, Inc) is discharged in descending aorta.With four branch people
Work blood vessel (French Intervascular companies production) and descending aorta row end to end anastomosis.It coincide after terminating, by arterial perfusion pipe
It is connected with the perfusion branch of Four branches aortic graft, blocks artificial blood vessel to irrigate the proximal part of branch, recovers lower part of the body perfusion.Kiss
Opened after closing left common carotid artery, recover brain perfusion.Coincide left subclavian artery, is opened, starts simultaneously at rewarming.Then
Four branches aortic graft proximal part is coincide with aorta ascendens.Open aorta ascendens, spontaneous rebeating or electric shock rebeating.By normal
Rule continue rewarming, auxiliary circulation, shutdown, hemostasis and close chest.
By embodiment 1~3 (3D technology assisted group) and comparative example (bending set of permutations entirely) statistical analysis follow-up investigation, table 1 is
The general information of preoperative two groups of patients compares, and table 2 is postoperative outcome.
The general information of 1 two groups of Stanford A type aortic arch interlayer patients of table compares
Note：- it is no data；Measurement data is usedRepresent；A measurement datas are t values, enumeration data x2Value.
In 2 two groups of Stanford A type aortic arch interlayer patient's arts of table and post-surgical condition compares
Note：- it is no data
Two groups of patients obtain successful surgery, none death.During two groups of patients are in hospital in art and post-surgical condition ratio
Relatively it is shown in Table 2.Wherein bend set of permutations row Bentall arts 5, Wheat arts 2, aorta ascendens displacement+aortic valvular valvuloplasty 5 entirely
Example；3D technology assisted group row Bentall arts 7, Wheat arts 3, aorta ascendens displacement+aortic valvular valvuloplasty 2.Quan Gong
There is postoperative of short duration, slight mental symptom 2 in set of permutations, after the symptomatic treatments such as sweet dew dehydration of alcohols, brain cell nutrition respectively at
Recover within 5th day and the 6th day normal；Delayed recovery 1, patient is clear-headed at night in postoperative 2nd day, no disorder of limb's activity；Because of art
Anthemorrhagic difficulty delayed sternal closure 4 afterwards；Hoarseness l examples.3D technology Computer Aided Design group all once closes chest, postoperative not occur brain
Complication.The hoarse person of voiceless sound.The true chamber recovery rate of the adherent satisfaction rate of two pack supports, support portions and support portions vacation chamber disappear
Or thrombus filling rate is 100%.
Comparative example group follow-up 13~48 months, month after operation check sustainer CTA and ultrasonic cardiography diagram are answered without aneurysm
Hair, without the complication related to artificial blood vessel, l example hoarseness persons do not recover, and remaining patient is without special main complaint.Embodiment
Group follow-up 9~21 months, two groups of patients recover good, the expansion satisfaction of descending aorta inner support, embodiment group patient's month after operation
Check sustainer CTA and ultrasonic cardiography diagram aortic arch and brachiocephalic artery inner support expands adherent satisfaction, do not occur obvious
Blood flow velocity is made a variation in internal fistula and support, branch vessel inner support patency rate 100%, and corresponding site vacation chamber is disappeared or thrombus is filled out
Fill.Without the complication related to support film-coated vascular.Have no aortic valve disease exacerbation and aortic coaractation；All patients without
Artificial blood vessel's occlusion and infection.
The present invention achieves relatively satisfactory nearly mid-term effect by clinical practice, and its advantage has：1. obtain individuation overlay film
The support time is short, from obtaining patient sustainer CTA data, to printing 1:1 3D models, required time is short, 3-4 hours
Complete, suture individuation overlay film frame about 20 minutes.Sewing process can be completed the surgery anesthesia preparatory stage in patient, be not take up
Operating time.2. obtained overlay film frame closer to the arch of aorta and its branch's physiological structure, can be accurate using blotting
Head arm blood vessel is obtained in the aperture position of the arch of aorta, accurately can be opened a window on main support, according to head arm blood vessel it is actual walk
To suture branch stent so that overlay film frame is more bonded vascular wall.3. operation technique is simplified, preoperative by big blood vessel 3D
The analysis of model, lesion situation is grasped, surgery planning can be carried out in advance, without free bow portion and head arm blood vessel, individuation overlay film
Support release after make coincide become relatively easy, by support extend to bow near-end coincide with aorta ascendens, far beyond depth bow drop
Portion easily operates, and bow portion only has an otch, is easy to stop blooding.4. operating time is short, previous anastomotic is reduced, and the tissue that dissociates is few, bleeding
Few, bleeding stopping period is reduced, and greatly shortens operation time.It is overall to shorten operating time.5. postoperative hemorrhage is few, blood transfusion is few, by
Reduced in previous anastomotic, cardiopulmonary bypass time shortens, and blood constituent is destroyed and reduced, and blood coagulation function is reduced, and operation is overall
Time is short, is advantageous to stop blooding so that amount of bleeding greatly reduces, and reduces the generation of blood transfusion associated lung injury.Followed in vitro 6. reducing
Ring is influenceed, and reduces operation and cardiopulmonary bypass surgery time, farthest reduces the possibility of bleeding, and this Improved approach is reduced
Three, bow portion previous anastomotic, and make to appear difficult bow distal anastomosis mouth and move to bow near-end and easy to operation and hemostasis, so
The Deep Hypothermia Circulatory Arrest time can be shortened, farthest reduce the chance of such operative hemorrhage.
Embodiment described above is only that the preferred embodiment of the present invention is described, not to the model of the present invention
Enclose and be defined, on the premise of design spirit of the present invention is not departed from, technical side of the those of ordinary skill in the art to the present invention
The various modifications and improvement that case is made, it all should fall into the protection domain of claims of the present invention determination.
Claims (5)
1. it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film frame method, its feature exists
In comprising the following steps：
（1）3D printing technique 1 is utilized by the CT view data of patient:1 replicates patient's lesion arch of aorta；
（2）Vessel branch opening, position and the size of the arch of aorta are marked on transparent membrane using sustainer 3D models；
（3）Overlay film main support is taken, is covered using labeled transparent membrane on overlay film main support, and in branch vessel correspondence position
On perforate successively, obtain the overlay film main support of perforate；
（4）The small overlay film frame that diameter matches with support opening diameter is chosen, is sewn in each tapping respectively, and is ensured after sewing
Branch's trend moves towards identical with actual vessel, produces the individuation overlay film frame matched completely with the patient.
2. it is according to claim 1 it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film branch
The method of frame, it is characterised in that step（1）The CT view data by patient utilizes 3D printing technique 1:1 replicates patient
The lesion arch of aorta comprises the following steps：
（11）Patient sustainer bow position scan data is obtained using helical CT scanners；
（12）Scan data is subjected to aortic arch three-dimensional reconstruction；
（13）The aortic arch model data Input Software handled well is subjected to section plus support processing；
（14）The data file after adding support processing that will cut into slices imports 3D printer printing.
3. it is according to claim 1 it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film branch
The method of frame, it is characterised in that step（2）The blood vessel for marking the arch of aorta on transparent membrane using sustainer 3D models
Branch openings, position and size comprise the following steps：
（21）The aortic arch model printed is removed into aortic arch vessel branch, branch is exposed and is opened in the arch of aorta
Mouthful；
（22）Transparent membrane is cut into suitable size, is covered at branch openings, on transparent membrane at corresponding opening position
The big mark such as do；
（23）The transparent membrane at mark position is removed, obtains open amount, position and size with opening on aortic arch model
The transparent membrane that mouth matches.
4. according to claim 1 or 3 it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation cover
The method of membrane support, it is characterised in that：The material of the transparent membrane is polypropylene.
5. it is according to claim 1 it is a kind of it is quick prepare for treat aortic arch interlayer art in individuation overlay film branch
The method of frame, it is characterised in that step（3）The diameter of the perforate is more than 10 ~ 20% of aperture on transparent membrane.
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