Name: a personalized 3d-printed model for preoperative evaluation in thyroid surgery
Uploaded: 2023-02-17T13:50:00
Description: Watch this Scientific Journal Video about A Personalized 3D-Printed Model for Preoperative Evaluation in Thyroid Surgery at JoVE.com

本研究得到了四川省卫生健康委员会（批准号：20PJ061）、国家自然科学基金（批准号：32101188）和四川省科技厅一般项目（批准号：2021YFS0102）的支持。

这项研究不需要获得患者的批准或任何形式的同意即可使用和发布他们的数据，因为本研究和视频中的所有数据和信息都是匿名的。
1. 图像数据的收集
<ol><li>通过增强型计算机断层扫描（CT）扫描患者的甲状腺，以获得DICOM格式的图像数据。确保此过程在操作前 1 周内完成，并控制切片厚度，使其为 ≤1 毫米。</li>
</ol>2. DICOM数据的处理</str...

<ol>
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对于大多数接受甲状腺手术的患者来说，超声可能是唯一的术前成像程序15。然而，少数分化良好的病例可能患有晚期疾病，这些疾病侵入周围组织或器官并阻碍手术16。这种模式可能更适合远晚期甲状腺癌患者。当疾病进展时，额外的CT扫描有助于进一步诊断。该模型基于CT扫描，与目前可访问的批量生产的甲状腺模型相比，CT扫描提供了更多的解剖学和形态学...

甲状腺结节是最常见的内分泌疾病之一，其中甲状腺癌占14%-21%1。甲状腺癌的首选治疗方法是手术。但由于甲状腺位于颈前部区域，手术区有靠近甲状腺的重要组织和器官，如甲状旁腺、气管、食道、颈大血管和神经2、3等，使得手术难度较大，风险较大。最常见的手术并发症是由甲状旁腺功能损伤引起的甲状旁腺功能下降或喉返神经损伤引起的错误切除和声音嘶哑4。减少上述手术并发症一直是外科医生的目标。甲状腺手术前最常见的成像方法是超声成像，尽管其对甲状旁腺和神经的显示非常有限5。此外，甲状旁腺和喉返神经在甲状腺手术区的位置变化很大，阻碍了识别6，7。如果在手术过程中能够通过模型实时向外科医生清晰显示每个患者的解剖位置，将降低甲状腺手术的操作风险，降低并发症的发生率，提高甲状腺手术的效率。
此外，在手术前向患者彻底解释手术过程也具有挑战性。一些没有经验的外科医生发现很难向患者解释和传达手术的确切细节，特别是因为甲状腺及其周围结构的复杂性。每个患者都有自己独特的解剖结构和个人需求8.因此，基于患者真实解剖结构的个性化3D甲状腺模型可以有效地帮助患者和临床医生。目前，市场上的大多数产品都是基于平面图批量生产的。通过利用3D打印技术生成反映每个患者个人医疗需求的特定于患者的模型，该模型可用于评估甲状腺癌患者的实际情况，并帮助外科医生更好地与患者沟通疾病的性质。
3D打印（或增材制造）是由计算机辅助设计模型或数字3D模型9构建的三维结构。它已被用于许多医疗应用，例如医疗设备，解剖模型和药物制剂10。与传统成像相比，3D打印模型更清晰可见。因此，3D打印越来越多地用于现代外科手术。常用的3D打印技术包括基于还原聚合的打印，基于粉末的打印，基于喷墨的打印和基于挤出的打印11。在基于还原聚合的印刷中，特定波长的光被照射到光固化树脂桶上，该树脂一次一层局部固化树脂。具有节省材料、打印速度快等优点。粉末印刷依靠局部加热将粉末材料融合为更致密的结构，但也导致印刷时间和成本的显着增加，目前使用有限12。基于喷墨的印刷使用逐层工艺将液滴精确喷涂到承印物上。该技术最为成熟，具有材料兼容性高、成本可控、打印时间快等优点13.基于挤出的印刷通过喷嘴挤出溶液和悬浮液等材料。该技术利用细胞，因此具有最高的软组织模拟能力。由于较高的成本和生物亲和力，它主要用于组织工程领域，较少用于外科器官模型14。
因此，我们根据甲状腺及其周围结构的复杂性以及手术时间表选择了“白色喷射工艺”打印技术。该技术结合了基于还原聚合的打印和基于喷墨的打印的优点，并提供高精度，快速和低成本，使其非常适合甲状腺手术。该协议的目的是制作3D打印的甲状腺癌模型，通过提供有关患者解剖结构和变异的充分信息来改善患者的预后，并更好地告知医生和患者与手术过程相关的所有情况。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3D color printer</td>
			<td>Zhuhai Sina 3D Technology Co</td>
			<td>J300PLUS</td>
			<td>Function support: automatic optimized placement, automatic model typesetting, automatic generation support, real-time layered edge cutting and printing, slice export, custom color thickness, custom placement / scaling, man hour evaluation, material consumption evaluation, print status monitoring, material remaining display, changing materials and colors, managing work queues, full / semi enclosed printing, automatic detection of model interference, layer preview, automatic pause of ink shortage, power failure to resume printing Automatic cleaning nozzle, automatic channel adaptation, ink change, automatic cleaning pipeline, follow-up laying. Range of optional materials: RGD series transparent molding materials, RGD series opaque molding materials, FLX series soft molding materials, ABS like series molding materials, high temperature resistant molding materials, Med series molding materials (first-class medical record certification), ordinary supporting materials, water-soluble supporting materials.</td>
		</tr>
		<tr>
			<td>Mimics 21.0 software&#160;</td>
			<td>Materialise, Belgium</td>
			<td></td>
			<td>DICOM data processing</td>
		</tr>
	</tbody>
</table>

a personalized 3d-printed model for preoperative evaluation in thyroid surgery

甲状腺癌手术区域的解剖结构很复杂。术前全面仔细地评估肿瘤位置及其与囊、气管、食道、神经和血管的关系非常重要。本文介绍了一种基于计算机断层扫描（CT）DICOM图像的创新3D打印模型建立方法。我们针对每位需要甲状腺手术的患者建立了个性化的颈椎甲状腺手术领域3D打印模型，帮助临床医生评估手术的关键点和难点，选择关键部位的操作方法作为依据。结果表明，该模型有利于术前讨论和手术策略的制定。特别是，由于甲状腺手术视野中喉返神经和甲状旁腺位置的清晰显示，可以避免在手术过程中对它们的伤害，降低甲状腺手术的难度，并降低术后甲状旁腺功能减退症和喉返神经损伤相关并发症的发生率。此外，这种3D打印模型非常直观，有助于患者在手术前签署知情同意书。

本文提出了一种构建患者甲状腺个性化3D打印模型的方案。图1显示了为患者甲状腺建立个性化3D打印模型的流程 图 。 图2 显示了用于患者甲状腺的个性化3D打印模型打印设备。 图3 显示了为甲状腺患者建立个性化3D打印模型的软件界面。视频中详细介绍了显示的界面。 图4 显示了患者甲状腺个性化3D打印模型...

Watch this Scientific Journal Video about A Personalized 3D-Printed Model for Preoperative Evaluation in Thyroid Surgery at JoVE.com

A Personalized 3D-Printed Model for Preoperative Evaluation in Thyroid Surgery

本文提出了一种建立个性化3D打印模型用于甲状腺手术术前评估的新方法。有利于术前讨论，降低甲状腺手术难度。

用于甲状腺手术术前评估的个性化3D打印模型

The anatomic structure of the surgical area of thyroid cancer is complex. It is very important to comprehensively and carefully evaluate the tumor ...

在这项研究中，我们的目标是通过个性化的3D甲状腺模型来改善甲状腺手术的术前评估、患者沟通和手术确定性。这种技术可以用更少的时间和成本非常勇敢地恢复甲状腺与周围结构之间的关系。如果我们能获得高精度的3D图像或个性化的3D模型就可以满足。例如，肝脏手术。开始通过增强的计算机断层扫描来扫描患者的甲状腺，以获得DICOM格式的图像数据。将扫描的图像数据导入软件，并根据甲状腺与周围组织或器官之间的灰度值差异设置适当的阈值。由于不同的灰度值反映了人体不同部位强度的差异，因此将灰度阈值设置为226至1500以显示骨骼图像，将阈值设置为负200至226以显示甲状腺图像。让软件自动识别框框区域，或者在识别不满意时手动勾勒出目标区域的边界。从重建的数据模型生成 STL 文件。在重建的3D模型上获得医生的批准后，将STL文件数据传输到彩色材料3D打印机，通过支持的3D打印切片软件设置参数预设。根据成品类型选择印刷型号。彩色印刷模型通常使用白色喷射工艺技术。而感光树脂则采用数字光处理。根据产品的厚度选择切片描边厚度参数。这里，23到36微米。根据印刷模型的细度选择支撑方法，要么是整体支撑以获得更好的保护并减少对精细细节的损坏，要么是节省材料的部分支撑。然后使用打印机上的调色板功能选择模型着色。用红色255统一动脉，用蓝色255统一静脉。在3D打印机中填充硬光固化树脂。调试打印平台并使用白色喷射工艺技术进行打印。打印后，取出初步打印的甲状腺模型。通过用戴手套的手将支撑物分解并缠绕在初步模型周围来减去支撑结构，并移除支撑结构的大部分主体。将模型放入装有氢氧化钙碱性溶液的超声波清洁器中，进行 15 分钟的清洁。将模型放入湿喷砂机中并冲洗，直到表面上的其余支撑结构被冲走。接下来，用电动磨床锉刀或砂轮磨削模型。研磨后，将清漆喷洒在模型表面的一半大面积色块中。然后用清漆手动绘制小面积色块。接下来，将模型放入UV固化机中固化30秒。然后取出模型并用95%的酒精清洁。包装完成的甲状腺模型，并在手术前完成交付给外科医生。按照这种方法，在甲状腺癌患者手术前，通过增强的计算机断层扫描构建了甲状腺区域的完整3D打印模型。高质量的3D图像是打印的基础。WGP打印技术是高质量3D模型的关键点。

Research

JoVE Journal

Medicine

Screening for Melanoma Modifiers using a Zebrafish Autochthonous Tumor Model

对黑色素瘤修饰符一个斑马鱼原地肿瘤模型的筛选

Genomic studies of  human cancers have yielded a wealth of information about genes that are altered  in tumors1,2,3. A challenge arising from these ...

科研

医学

Evaluation of Tumor-infiltrating Leukocyte Subsets in a Subcutaneous Tumor Model

在皮下肿瘤模型的评估肿瘤浸润白细胞亚群

Specialized immune cells that infiltrate the tumor microenvironment regulate the growth and survival of neoplasia.&#160; Malignant cells must elude or ...

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

用于评估椎弓根螺钉的麻醉，手术和收获方法<em&gt;体内</em&gt;猪腰椎模型

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model

猪手术模型对甲状腺手术的手术内神经监测

Intraoperative injury to the recurrent laryngeal nerve (RLN) can cause vocal cord paralysis, which interferes with speech and can potentially interfere ...

Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease

在缺血性心脏病的猪模型中部署3D打印冠状动脉狭窄植入物的新颖的皮下方法

Minimally invasive methods for creating models of focal coronary narrowing in large animals are challenging. Rapid prototyping using three-dimensionally ...

Standardized Histomorphometric Evaluation of Osteoarthritis in a Surgical Mouse Model

手术小鼠模型中骨关节炎的标准化形态学评价

One of the most prevalent joint disorders in the United States, osteoarthritis (OA) is characterized by progressive degeneration of articular cartilage, ...

Development and Evaluation of 3D-Printed Cardiovascular Phantoms for Interventional Planning and Training

干预规划和培训的3D打印心血管幻影的开发与评估

Catheter-based interventions are standard treatment options for cardiovascular pathologies. Therefore, patient-specific models could help training ...

Retinal Pathophysiological Evaluation in a Rat Model

大鼠模型中的视网膜病理生理学评估

A posterior segment eye disease like diabetic retinopathy alters the physiology of the retina. Diabetic retinopathy is characterized by a retinal ...

Establishment and Evaluation of a Porcine Vein Graft Disease Model

猪静脉移植病模型的建立与评价

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the ...

Investigation of the Electrophysiological and Thermographic Safety Parameters of Surgical Energy Devices During Thyroid and Parathyroid Surgery in a Porcine Model

猪模型中甲状腺和甲状旁腺手术中手术能量装置的电生理和热学安全参数研究

In thyroid and parathyroid surgery, surgical energy devices (SEDs) provide more efficient hemostasis than conventional clamp-and-tie hemostasis in areas ...