3D打印联合荧光胸腔镜在解剖性肺段切除中的应用——基于倾向性匹配评分的病例对照研究

Application of 3D printing combined with fluorescence thoracoscopy in anatomical segmentectomy: a case-control study based on propensity score matching

摘要:

目的 评价3D打印联合荧光胸腔镜在解剖性肺段切除中的安全性及有效性。方法 选取2022年6月—2023年6月在北京航天总医院实施肺段切除术的108例患者，按照1∶2进行倾向性匹配评分，试验组（3D打印联合荧光胸腔镜下肺段切除术）33例，对照组（三维重建解剖性肺段切除术）75例。比较两组患者围手术期指标、肺功能指标及不良反应。结果 试验组手术时间、引流管置管时间、术后住院均较对照组短（P <0.05），术中出血量较对照组少（P <0.05），淋巴结清扫数较对照组多（P <0.05）。两组患者不良反应发生率比较，差异无统计学意义（P >0.05）。两组患者术前用力肺活量百分比（FVC%pred）、第1秒用力呼气容积占预计值百分比（FEV₁%pred）、最大分钟通气量百分比（MVV%pred）比较，差异均无统计学意义（P >0.05）。试验组术后3 d FVC%pred、FEV₁%pred、MVV%pred均较对照组高（P <0.05）。结论 3D打印肺血管-气管-结节-切缘球模型联合荧光胸腔镜，安全有效，可准确定位，快速识别段间平面，值得推广应用。

Abstract:

Objective To evaluate the safety and effectiveness of 3D printing combined with fluorescence thoracoscopy in anatomical segmentectomy.Methods The 108 patients who underwent segmentectomy at Beijing Aerospace General Hospital from June 2022 to June 2023 were selected, and propensity score matching (PSM) was performed in a 1 : 2 ratio. Thirty-three cases were included in the experimental group (segmentectomy guided by 3D printing combined with fluorescence thoracoscopy), and 75 cases were included in the control group (3D reconstruction-guided anatomical segmentectomy). The perioperative indicators, pulmonary function, and complications were compared between the two groups.Results Compared with the control group, the operative duration, the duration of drain placement, and the postoperative length of hospital stay were shorter (P < 0.05), the intraoperative blood loss was less (P < 0.05), and the number of lymph nodes dissected was greater in the experimental group (P < 0.05). There was no statistical difference between the two groups in the incidence of adverse reactions (P > 0.05), or in the preoperative forced vital capacity percent predicted (FVC%pred), forced expiratory volume in one second percent predicted (FEV₁%pred), and maximum voluntary ventilation percent predicted (MVV%pred) (P > 0.05). The FVC%pred, FEV₁%pred and MVV%pred 3 days after surgery were higher in the experimental group compared with the control group (P < 0.05).Conclusions The 3D-printed pulmonary vascular-tracheal-nodule-margin sphere model combined with fluorescence thoracoscopy is safe and effective, enabling accurate localization and rapid identification of intersegmental planes, making it highly recommended for broader clinical application.