CN114869432A - 3D printing customized hysteromyoma stripping operation guide plate and using method thereof - Google Patents
3D printing customized hysteromyoma stripping operation guide plate and using method thereof Download PDFInfo
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/42—Gynaecological or obstetrical instruments or methods
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- A—HUMAN NECESSITIES
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B29—WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE IN GENERAL
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Abstract
The invention discloses a 3D printing customized hysteromyoma stripping operation guide plate and a using method thereof, wherein the hysteromyoma stripping operation guide plate comprises a bottom plate, the bottom plate is printed based on a uterine model, and the bottom plate is attached to organism tissues of a patient; a positioning hole is formed in the bottom plate, and the binding surface of the bottom plate is right opposite to the uterus direction of a patient when viewed from top; the using method comprises the following steps: carry out three-dimensional reconstruction according to multiple uterus myoma patient pelvic cavity image data before the art, design the baffle and use 3D printing technique preparation on this basis, put into the back at the baffle in the art, the guide pin is with the pilot wire through the locating hole to target myoma location, takes out guide plate and guide pin after the location, explores target myoma through the pilot wire, takes out the pilot wire when peeling off the myoma. The 3D printing customized hysteromyoma stripping surgical guide plate and the use method thereof aim at improving the surgical precision of a surgeon, reducing the trauma of the uterus, shortening the surgical time and reducing the residual rate and the recurrence rate after surgery.
Description
Technical Field
The invention relates to the technical field of gynecology, in particular to a 3D printing customized hysteromyoma stripping operation guide plate and a using method thereof.
Background
Hysteromyoma, the most common benign tumor of the female reproductive system, is composed of diseased smooth muscle and connective tissue, and is mostly seen in women of 30-50 years old; the incidence of hysteromyoma in China is obviously increased in recent years, and the fertility of women in the childbearing period is influenced; affected by secretion of estrogen, the incidence rate of women in the reproductive age is 20-40%;
submucosal myoma classified by uterine myoma refinement can reduce pregnancy rate of pregnant women; the intramural myoma can improve the pregnancy yield and reduce the success rate of In Vitro Fertilization (IVF), even if the myoma does not influence the uterine cavity shape, the IVF pregnancy rate and the birth survival rate of women in the childbearing age with more than two myomas or the myomas with the diameter larger than 3cm can be obviously reduced;
for the patients with the symptoms of fertility influence or menstrual disorder, the surgical treatment is still the most effective treatment method at present;
the surgical treatment mode of the uterine fibroid comprises myoma stripping operation and hysterectomy: hysterectomy can achieve a radical effect, but also brings serious consequences, such as permanent loss of fertility, obvious increase of the risk of secondary pelvic organ prolapse and the like, which obviously do not meet the requirements of patients; the laparoscopic hysteromyoma stripping operation has the advantages of wide operation indication range, micro-wound, safety and the like, can not only keep the fertility function and organ integrity of a patient, but also maintain the pelvic floor function and blood supply of ovaries, and is a preferred operation mode in clinic at present;
at present, the positioning and the stripping of the myoma with the diameter more than 5cm in the multiple uterine fibroids are not difficult, but for the myoma between III-V type uterine muscle walls (according to the classification method of the uterine fibroids 9 of the International gynaecological Union), particularly the positioning and the stripping of the myoma with the diameter less than or equal to 3cm have great difficulty, and the postoperative residual rate is high; research finds that in women in the childbearing age, the position and the size of the hysteromyoma are obviously related to the growth speed of the hysteromyoma, the growth speed of the III-V type hysteromyoma is obviously higher than that of other types of hysteromyoma, and the growth speed of the hysteromyoma with the diameter less than or equal to 3cm and more than or equal to 5cm is 3 times that of other hysteromyoma; therefore, the residual of the small myoma between the muscle walls after the operation causes the corresponding increase of the recurrence rate, thereby increasing the risk of the re-operation; according to the related report, the recurrence rates of 1, 3, 5 and 8 years after laparoscopic hysteromyoma ablation are 11.7%, 36.1%, 52.9% and 84.4%, respectively. The multiple hysteromyoma is an independent risk factor of recurrence, the recurrence rate of patients with myoma number more than or equal to 2 after laparoscopic hysteromyoma stripping operation is obviously increased, and the secondary operation risk of the patients can be reduced by stripping all the myoma as much as possible in the operation;
in the laparoscopic hysteromyoma stripping operation, after the multiple hysteromyoma is stripped, a plurality of wound surfaces exist on the surface of the uterus. The suture of the wound surface after the III-V type intramural myoma is stripped is a difficult point of laparoscopic hysteromyoma resection, poor suture can cause hematoma and poor healing of uterine incision, further uterine rupture can be caused during postoperative pregnancy, and the life safety of a patient is endangered; in addition, after a plurality of myomas are sequentially removed, the anatomical morphology of the uterus can be obviously changed, so that the positioning difficulty of the sequentially removed myomas is increased;
the conventional method for acquiring anatomical information by utilizing two-dimensional tomography at present has great defects in cases with complex disease focus conditions and special positions; for gynecologists, a way is urgently needed, the position and the size of the uterine fibroid of a patient and the adjacent condition of surrounding tissues can be intuitively reflected before an operation, the difficulty of change of the anatomical form of the uterus can be overcome in the operation, and an operator is guided to accurately position the III-V type uterine fibroid with the diameter less than or equal to 3cm and deeper position, so that the operation accuracy of the operator is improved, the uterine wound is reduced, the operation time is shortened, and the residual rate and the recurrence rate after the operation are reduced.
Therefore, we propose a 3D printing customized hysteromyoma stripping surgical guide plate and a method of using the same so as to solve the problems proposed in the above.
Disclosure of Invention
The invention aims to provide a 3D printing customized hysteromyoma stripping surgical guide plate and a using method thereof, which aim to solve the current urgent need of a mode provided by the background technology, can visually reflect the position and the size of the hysteromyoma of a patient before an operation and the adjacent condition of surrounding tissues, can overcome the difficulty of changing the anatomical form of the uterus during the operation and guide an operator to accurately position the III-V type hysteromyoma with the diameter less than or equal to 3cm and deeper position; thereby improving the operation precision of the operator, reducing the trauma of the uterus, shortening the operation time and reducing the residual rate and the recurrence rate after the operation.
In order to achieve the purpose, the invention provides the following technical scheme: the 3D printing customized hysteromyoma stripping operation guide plate matched with the guide needle and the positioning wire comprises a base plate, wherein the base plate is formed by printing based on a uterus model and is attached to organism tissues of a patient;
the inner part of the bottom plate is provided with a positioning hole, the operating surface of the positioning hole is convexly provided with a boss integrated with the bottom plate, and the side of the positioning hole is printed with a hole depth size;
the side of the bottom plate is provided with a fixing hole, and the end part of the bottom plate is provided with a positioning groove.
Preferably, the abutting surface of the bottom plate faces towards the uterus of the patient in a plan view.
Preferably, the width of the bottom plate is not less than 1.5cm, so that the bottom plate is prevented from being broken and injuring surrounding tissues and organs during operation and use; the width of the bottom plate is not more than 2cm, so that the difficulty in placing and taking out the abdominal cavity through the incision is avoided; and the thinnest part of the bottom plate is 3mm in size.
Preferably, the positioning hole is integrally hollow cylindrical, the inner diameter width of the positioning hole is 2.2-2.5mm, and the height of the positioning hole is 4.8-5.8 mm.
Another technical scheme provided in the scheme is to provide a use method of the 3D printing customized hysteromyoma ablation operation guide plate matched with a guide needle and a positioning wire, wherein the use method of the guide plate comprises the following steps:
the method comprises the following steps: preoperative preparation, pelvic cavity imaging data of a patient with the polymyosoma are extracted, and a color resin material is used for 3D printing to obtain a product 1:1, a patient uterine model and a myoma model thereof;
step two: marking deep refractory myomas needing to be positioned and stripped on the uterine model, providing a corresponding operation access for each myoma, and printing a uterine fibroid stripping operation guide plate with a positioning hole;
step three: in the laparoscopic hysteromyoma stripping operation, before the hysteromyoma is stripped, a locating groove (the design of the locating groove is based on a special locating point identified by preoperative imaging) is matched to place the hysteromyoma stripping operation guide plate at a preset position on the surface of the uterus;
step four: the guide needle carries a positioning wire to enter uterine tissue through a positioning hole of the hysteromyoma stripping operation guide plate, the operation is stopped after reaching a pre-operation preset puncture depth, the guide needle is taken out through the positioning hole, and the positioning wire can be embedded in the myoma position;
step five: repeating the fourth step until all the target hysteromyomas planned before the operation are embedded into the positioning wires, and taking out the guide plate;
step six: and (3) stripping the hysteromyoma one by one according to a preoperative surgical scheme, and taking out the positioning wire while stripping.
Preferably, the 3D printing customized hysteromyoma stripping surgical guide plate is made of a peek material, a photosensitive resin, a pp material or a pc material.
Compared with the prior art, the invention has the beneficial effects that: the 3D printing customized hysteromyoma stripping operation guide plate and the use method thereof,
the 3D printing customized hysteromyoma stripping operation guide plate completely uses implantation-grade materials such as peek and the like, the implantation-grade materials are subjected to complete biocompatibility test according to the ISO10993 standard, and the implantation-grade materials have excellent biocompatibility, no cytotoxicity, no mutagenicity, no carcinogenicity, no allergy and safe in vivo entry, and have X-ray penetrability and good visibility, and doctors can also adjust in real time according to MRI or CT during implementation of hysteromyoma stripping operation;
the scheme breaks through the traditional body surface use mode of the guide plate, and realizes the application of 3D printing of the hard positioning guide plate on soft tissues (human organs);
the guide plate can be used in combination with an operation scheme based on the optimal myometrium incision and suture mode made by a preoperative doctor, and a guide operator can strip all uterine fibroids with the diameter of more than or equal to 1cm and less than or equal to 3cm to the maximum extent in the operation, so that the residual rate and the recurrence rate after the operation are reduced;
meanwhile, an indefinite number of fixing holes (the diameter is 1 mm) are added at the edge of the bottom plate, an operator ties a surgical thread on one hole before placing the guide plate, and withdraws the guide plate after withdrawing the guide needle, so that the operator can conveniently pull out the guide plate through the assistance of the surgical thread;
the rest fixing holes are used for fixing the guide plate by sewing the guide plate on the uterus through the perforation of the operation line after the operator places the guide plate and determines the position of the guide plate and before the guide needle is inserted;
the end part of the bottom plate is provided with a positioning groove, and the positioning grooves on the two sides are designed as special positioning points of uterus which can be identified by imaging during preoperative planning;
the method is beneficial to improving the operation accuracy, reducing the uterine wound, reducing the intraoperative hemorrhage, shortening the operation time, reducing the occurrence of postoperative complications, shortening the hospitalization time and reducing the postoperative residual rate and the recurrence rate; in addition, the 3D printing customized hysteromyoma stripping operation guide plate is short in production period, strong in operability and repeatability, capable of greatly reducing operation difficulty, easy to popularize and promote and beneficial to more patients.
Drawings
FIG. 1 is a schematic view of the whole structure of the hysteromyoma-removing surgical guide plate 1;
fig. 2 is a schematic view of the whole structure of the hysteromyoma-stripping operation guide plate 2.
In the figure: 1. a base plate; 2. positioning holes; 3. a boss; 4. and (7) fixing holes.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
Referring to fig. 1-2, the present invention provides the following technical solutions: the 3D printing customized hysteromyoma stripping operation guide plate and the use method thereof, wherein the 3D printing customized hysteromyoma stripping operation guide plate matched with a guide needle and a positioning wire comprises a base plate 1, the base plate 1 is formed by printing based on a uterine model, and the base plate 1 is attached to organism tissues of a patient; wherein, the inside of bottom plate 1 has seted up locating hole 2, and the operation face of locating hole 2 is provided with the protruding boss 3 of an organic whole between with bottom plate 1.
The hysteromyoma stripping surgical guide plate is designed to comprise a bottom plate 1 and a positioning hole 2. The whole base plate 1 is in an irregular shape band shape and accurately fits the actual tissue of a patient based on a uterus model; the operation surface is designed to be the direction facing the uterus of the patient for the operation of the operator; the length of the guide plate is determined according to the surgical approach, the guide needle needs to be confirmed to reach all deep refractory myomas to be stripped through the shortest path, and the guide plate is difficult to enter the abdominal cavity through the incision due to the redundant length; the width of each part is not strictly set, but the central positioning hole is ensured to be in the middle position, the narrowest part is not less than 1.5cm to prevent the peripheral tissues and organs from being damaged by fracture in the operation and use process, and the widest part is not more than 2cm to prevent the abdominal cavity from being difficultly placed in and taken out through an incision; the thinnest part of the guide plate is 3mm (the principle is the same as the above).
The number of the positioning holes 2 is less than or equal to the number of the refractory hysteromyomas planned to be stripped, and the whole body is hollow cylindrical. The deflection angle design determines the puncture angle of the guide needle by the surgical approach proposed by the operator in the step two; the inner diameter width is designed to be 2.2-2.5mm (as the diameter of the guide needle is 2mm, the pore canal with the diameter not less than 2.2mm can fully ensure the guide needle to smoothly puncture and withdraw, and the maximum error of the final positioning point is in an acceptable range); the height is 4.8-5.8mm (the principle is the same as the width and thickness of the upper section).
The use method of the 3D printing customized hysteromyoma stripping operation guide plate matched with the guide needle and the positioning wire comprises the following steps that a modeler extracts pelvic cavity iconography data of a patient with the multiple hysteromyoma, and 3D printing is carried out by using a color resin material to obtain a result 1:1, the III-V type uterine fibroid with the diameter less than or equal to 3cm in the body of a patient can be intuitively and clearly observed;
after the operator is fully communicated with a patient and an operation team determines an operation scheme, the type of myoma needing to be stripped is calibrated on the model, a corresponding operation approach, namely a guide needle puncture point, a puncture angle and a puncture depth are provided for each myoma, and the information is a basis for designing a 3D printing hysteromyoma guide plate for modelers;
3D printing a patient uterine and a myoma model of 1:1 by using a color resin material on the basis of three-dimensional reconstruction according to the patient pelvic cavity imaging examination data, researching and designing a scheme, namely a 3D printing customized uterine fibroid stripping operation guide plate,
such as a hysteromyoma stripping surgical guide plate, which is shown in the attached drawings 1 and 2 of the specification, wherein the inner diameter of the positioning hole 2 is designed to be 2.2mm, the depth of the positioning hole 2 is correspondingly printed on the outer side of the positioning hole 2, and the depths of the positioning hole 2 are respectively 4.8mm, 5.3mm and 5.8 mm;
when in use, the utility model is matched with a guide needle and a positioning wire for positioning in operation and marking the III-V type hysteromyoma with the diameter less than or equal to 3cm and deeper;
when the uterine fibroid guide plate is used, an operator places the uterine fibroid guide plate on the surface of a uterus, places the uterine fibroid guide plate on the surface of the uterine wall, (the guide plate can be accurately placed at a planned position and is fixed in an auxiliary mode by using related instruments according to operation requirements during operation of the step), and the end part of the bottom plate 1 is provided with a positioning groove which is designed with a special uterine positioning point which can be identified by imaging, so that the guide plate is ensured to be stably fixed on the surface of the uterine wall in an operation. The guide needle enters the operation surface (the surface of the bottom plate 1, which is parallel to the positioning hole 2), the guide needle is attached with a positioning wire, enters uterine tissues through the positioning hole of the hysteromyoma stripping operation guide plate, the guide needle stops after reaching the preoperative preset puncture depth, the positioning guide needle is taken out through the positioning hole, and the positioning wire can be embedded in the myoma position. Repeating the operation until all the target uterine fibroids planned before the operation are embedded into the positioning wires,
wherein, the fixed orifices 4 have been seted up to the indefinite quantity in edge of bottom plate 1, and the art person wears a surgical suture to tie up on one of them hole before putting into the baffle, and the one step of baffle will be withdrawn from behind the guide pin of withdrawing from, the art person accessible this surgical suture is supplementary to be pulled out the baffle conveniently, peels this type hysteromyoma one by one according to the scheme before the art, takes out the registration screw when peeling.
By adopting the technical scheme, the 3D printing customized hysteromyoma stripping surgical guide plate uses the peek material, and the implant-grade peek is subjected to complete biocompatibility test according to the ISO10993 standard, so that the hysteromyoma stripping surgical guide plate has excellent biocompatibility, no cytotoxicity, no mutagenicity, no carcinogenicity, no allergy and safety in entering the body. In addition, the peek has X-ray penetrability and good visibility, and a doctor can also adjust the peek in real time according to MRI or CT during the implementation of hysteromyoma ablation;
the 3D printing customized hysteromyoma stripping surgical guide plate can also be made of photosensitive resin, pp materials or pc materials and other materials meeting surgical requirements such as biocompatibility and structural strength.
In addition, the guide plate can be used in combination with an optimal operation scheme based on myometrium incision and suture mode established by a preoperative doctor, and a guide operator can strip hysteromyoma with the diameter of more than or equal to 1cm and less than 3cm to the maximum extent in the operation, so that the postoperative residual rate and the recurrence rate are reduced. The scheme is expected to improve the operation precision of an operator, reduce the wound of the uterus, shorten the operation time and reduce the residual rate and the recurrence rate after the operation.
Those skilled in the art will recognize that other words, elements, and/or steps described in this specification are not necessarily required to be limited to the specific embodiments shown and described.
Although the present invention has been described in detail with reference to the foregoing embodiments, it will be apparent to those skilled in the art that various changes in the embodiments and/or modifications of the invention can be made, and equivalents and modifications of some features of the invention can be made without departing from the spirit and scope of the invention.
Claims (6)
1. With guide needle, pilot wire complex 3D print customization formula hysteromyoma and strip operation baffle, including bottom plate (1), its characterized in that: the bottom plate (1) is formed by printing based on a uterus model, and the bottom plate (1) is attached to organism tissues of a patient;
the inner part of the bottom plate (1) is provided with a positioning hole (2), the operating surface of the positioning hole (2) is convexly provided with a boss (3) integrated with the bottom plate (1), and the side of the positioning hole (2) is printed with a hole depth size;
the side of the bottom plate (1) is provided with a fixing hole (4), and the end part of the bottom plate (1) is provided with a positioning groove.
2. The 3D printing customized hysteromyoma stripping surgical guide plate matched with the guide needle and the positioning wire according to claim 1, which is characterized in that: the binding surface of the bottom plate (1) is right opposite to the uterus direction of a patient in overlook.
3. The 3D printing customized hysteromyoma stripping surgical guide plate matched with the guide needle and the positioning wire according to claim 1, which is characterized in that: the width of the bottom plate (1) is not less than 1.5cm, so that the bottom plate is prevented from being broken and injuring surrounding tissues and organs in the operation and use process; the width of the bottom plate (1) is not more than 2cm, so that the difficulty in placing and taking out the abdominal cavity through an incision is avoided; meanwhile, the thinnest part of the bottom plate (1) is 3 mm.
4. The 3D printing customized hysteromyoma stripping surgical guide plate matched with the guide needle and the positioning wire according to claim 1, which is characterized in that: the positioning hole (2) is integrally hollow cylindrical, the inner diameter width of the positioning hole (2) is 2.2-2.5mm, and the height of the positioning hole (2) is 4.8-5.8 mm.
5. The use method of the 3D printing customized hysteromyoma stripping surgical guide plate matched with the guide needle and the positioning wire according to claim 1, wherein the method comprises the following steps: the use method of the guide plate comprises the following steps:
the method comprises the following steps: preoperative preparation, pelvic cavity imaging data of a patient with the polymyosoma are extracted, and a color resin material is used for 3D printing to obtain a product 1:1 uterus and myoma models thereof;
step two: marking deep refractory myomas needing to be positioned and stripped on the uterine model, providing a corresponding operation access for each myoma, and printing a uterine fibroid stripping operation guide plate with a positioning hole;
step three: in the laparoscopic hysteromyoma stripping operation, before the hysteromyoma is stripped, the hysteromyoma stripping operation guide plate is placed at a preset position on the surface of the uterine wall;
step four: the guide needle carries a positioning wire to enter uterine tissue through a positioning hole of the hysteromyoma stripping operation guide plate, the operation is stopped after reaching a pre-operation preset puncture depth, the guide needle is taken out through the positioning hole, and the positioning wire can be embedded in the position of a target hysteromyoma;
step five: repeating the fourth step until all the target hysteromyomas planned before the operation are embedded into the positioning wires, and taking out the guide plate;
step six: and (3) stripping the hysteromyoma one by one according to a preoperative surgical scheme, and taking out the positioning wire while stripping.
6. The use method of the 3D printing customized hysteromyoma stripping surgical guide plate matched with the guide needle and the positioning wire according to claim 5, wherein the method comprises the following steps: the 3D printing customized hysteromyoma stripping operation guide plate is made of a peek material, photosensitive resin, a pp material or a pc material.
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