3D printing medical exploration: a person's surgery!
At 11:00 am on April 10th, 2016, in the office of Director Zheng Hong of Fuwai Hospital, together with a sound of soundness and affirmation, “the operation is very good and the recovery is also very good. It has not caused other and found images. Don't worry!", Director Zheng looked at the results of the review of Fu, who is over 70 years old, and said with a smile. At the moment, there are no fewer than three director-level experts in the house.
Maybe you will have doubts. What kind of case will cause such concern after a review? Let us put the time back, and freeze the day at the end of the Chinese Heart Intervention Conference, the moment...
"This surgery can't be successful!..." The doctors quietly left one by one, some shook their heads, some were afraid of people catching their feet and leaning over their toes and disappeared. Just now the crowded operating room Suddenly quieted down. On the morning of March 18th, 2016, the heart catheter room of Fuwai Hospital, the atmosphere was a little solidified, and the time seemed to be still. Fortunately, the patient did not see that the 70-year-old man was lying on the operating table with no purpose and no idea at the moment. A few days ago, his wheezing caused by a heart defect became more and more serious. Foreign hospitals for medical treatment, traditional thoracotomy, the psychological burden for him is too heavy, after all, seventy-somethings, he had no choice but to take the intervention to try to luck. Nowadays, his large and small display screens filled with his data images are constantly flashing. The clean and slightly cold operating room is only Zheng Hong. It is his chief surgeon, pushing the sheath and placing it. The second occluder was not very smooth. Many doctors turned around and left, but this is nothing. Zheng Hong believes that he has studied the 3D printed heart model of the patient many times. The surgical plan is complete, and the rest is one. A little bit serious and patient. "Does such a large defect not open the thoracic surgery?!" "Why don't you have an esophageal ultrasound before surgery?" "You can't do this. It is recommended to puncture the femoral veins on both sides and put two sets of delivery systems to place two plugging umbrellas." The voices of doubt in various preoperative operations have never been broken. At this point, people went to the room, but they were clean, and various arguments drifted from his ear like a cloud. "Give me a 26 PDA occluder." He firmly said, "26 umbrella should be more stable. ."
Figure 1. 2016 CIT Zheng Hong is using the 3D model to explain on the spot.
According to Zheng Hong's pre-designed plan, only the right femoral vein was punctured, and the upper central type of abscess was first released, and then the lower inferior chamber type of anterior chamber was found. The vascular catheter was closed with an occlusion catheter (PDA). Blocking, because the patient's pain and discomfort will be minimal, but the difficulty of surgery will increase a lot. It is okay to push the sheath tube unsatisfactory. He put the sheath tube into the left atrium by placing the dilatation tube and pulls back the PDA occluder to the lower chamber type housing. The fluoroscopy shows that the shape is well depressed. The occluder is the right size and does not detach from the push-pull. At this time, let the bedside ultrasound test to see if the occluder is in place? Because the patient has an enlarged tumor in addition to the porous defect, the ultrasound can not see the position of the occluder. In order to ensure that he was safe, he added a right heart angiography. After the contrast agent was recirculated, he saw that the occluder and the bottom of the left atrium were in place. He assuredly released the second occluder and then showed two The occluder perfectly closes the two large defects and securely sets them on the interatrial septum. The operation took 30 minutes and the time was fixed at 11:46 on March 18, 2016. Zheng Hong said plainly, "It’s done, it’s good." Then he happily took his two 3D heart tests. I came out and said, "I want to tell everyone about this." The 70-year-old man heard it and gratefully said "Thank you."
Figure 2. 2016 CIT International Conference Structural Heart Disease Main Session is undergoing interventional surgery demonstration
Hearing this thanks, in addition to Zheng Hong, there are thousands of cardiologists who are watching the live broadcast 20 kilometers away from the operating room - the 14th China Interventional Cardiology Congress (CIT) March 2016 From 17 to 20th, it was held in Beijing National Convention Center. More than 7,000 experts in the field of cardiovascular disease, interventional radiology and imaging, and other related health fields attended the conference. On March 18th, the surgery demonstration of structural heart disease interventional therapy was demonstrated and the live broadcast was performed as described above. Some prophetic doctors began to talk privately: "Traditional ultrasound, CT + 3D data trials create a more precise and safe surgical plan, March 18 this surgery may change the future of cardiovascular intervention in the world ..."
At 10 o'clock on the morning of March 18th, the surgical demonstration of "interventional treatment of congenital heart disease with multiple atrial septal defect and enlarged tumor formation" was officially started by Professor Zheng Hong from the Department of Interventional Therapy of Fuwai Hospital. The patient was treated as a 70-year-old male. A few years ago, he was diagnosed with congenital heart disease due to chest discomfort and his condition was special. Many hospitals were told that surgery was needed. Because the patient is old and fear can not withstand the huge damage of the surgery, he and his family are unwilling to accept and delay until now. This year, the patient's wheezing increased and was recommended by a friend to the Fuwai Hospital for treatment. It happened to meet Professor Zheng Hong's outpatient clinic. His echocardiographic findings were diagnosed as "atrial septal enlargement with multiple atrial septal defect", in which the larger defect was in close proximity to the inferior vena cava. Previously, this inferior vena cava was only treated by surgery. Professor Zheng Hong told his patients that his first use of PDA occluder interventional therapy can solve the problem of inferior cavity type without a knife, but it is recommended that patients customize a 3D printed "heart test" to further understand the "anatomy" of the defect and "Accuracy" to better choose the appropriate size of the plugging device.
Figure 3. Professor Zheng Hong is undergoing interventional therapy for multiple atrial septal defect (central + inferior) in the catheter room of Fuwai Hospital
In the interventional treatment program independently developed by Chinese doctors, the “heart test model†(that is, the data generated for 3D printing based on the patient's own CT scan results) is used as a new tool for clinical surgical simulation planning. The surgeons have a new dimension. In terms of the development of science and technology, precision medicine has already been on the road to benefit patients. Doctors like Zheng Hong who walk on this road are paranoid in many people, using ready-made materials and Isn't technology already good? Why bother to ask for custom-made precision? There are so many Chinese patients who don’t have patients. For doctors, it’s most important that they don’t have accidents. The patient’s word of mouth will be the best. Why bother to risk innovation? Besides, it is not more troublesome to use imported goods from abroad. Many patients think that foreign countries must be better than domestic ones. Why bother to innovate independently? Zheng Hong, a returnee returning from overseas, did not think he would lose to his foreign counterparts from the day he returned to China, and even went to the front of many international counterparts. Since 1994, he has not known how many times he has been looking for patients who are willing to undergo interventional therapy outside the B-ultrasound. At that time, the interventional surgery was not as popular as it is today. In his early years, his first few subjects were from B-outdoor outdoor. Blocked. Later, he himself studied the materials used as occluders, and the self-developed occluder that had received the test number was used in the clinic, and many patients were treated with cheap and good intervention for the treatment of heart defect repair. His uneasy and almost paranoid spirit of innovation has not been optimistic in many of his peers in his career as a safe and secure doctor. In recent years, he and the "immediately åç»´ data" (a professional organization that emphasizes the intellectual property rights of independent medical image data), which is also the life of independent innovation, hit it off. Since 2012, this research work has been carried out in China first, and has completed internationally. The first case of "3D printing guided aortic sinus aneurysm rupture intervention" and "3DP technical guidance using patent ductus arteriosus occluder intervention for the treatment of lower atrial septal defect" and so on. So far, Zheng Hong and “Immediately†have established the world's first three-dimensional database of structural heart disease, and its data scale has reached 1,000 levels. Zheng Hong said: "The 3D medical data of these structural heart diseases will make a huge contribution to surgical planning, interventional medical device design, medical education, etc., and ultimately benefit patients. This road is worth the effort."
Figure 4. Post-operative study of the 3D printed model with the peers.
In the past few years, they have produced more than 100 3D cardiac models of cardiovascular disease. Under these guidelines, they have completed dozens of special or complicated cardiovascular interventional and surgical procedures, many of which have been treated. There are innovations and breakthroughs. The "3DP technical guidance using the patent ductus arteriosus occluder for the treatment of the inferior cavity atrial septal defect" is to break the restricted area of ​​the inferior cavity type of insufficiency. "Proposing the feasibility of interventional treatment of partial right superior pulmonary venous malformation combined with superior cavity atrial stenosis and designing a trumpet-covered stent" and other special types of atrial septal, coronary artery fistula, pulmonary arteriovenous fistula and complex congenital heart disease Postoperative residual lesions are internationally leading and even the first. The successful implementation and success of the “interventional treatment of multiple inferior atrial septal defect with case of aneurysm formation†at the CIT International Conference benefited from the preoperative “immediately performed†cardiac test model. s help.
The ultrasound diagnosis of the interventional treatment case was multiple atrial septal defect, and the large defect was the inferior cavity type. The preoperative CT examination data and the converted 3D cardiac specimen showed three atrial defects and atrial septal enlargement. Tumor, the large atrial defect is narrow and wide, and the lower edge is borderless. At the beginning of the surgery demonstration, Professor Zheng Hong has completed the vascular puncture and right heart catheterization. Due to the expansion of the tumor, bedside ultrasound can not clearly show the shape, location and size of the atrial defect. Professor Zheng Hong can only use the largest domestic occluder to seal according to the patient's cardiac test pattern before 3D printing. Blocking. The surgeon first uses the PDA occluder to measure the upper part of the room, and then selects the appropriate size of the occlusion device for sealing. Then the selected PDA occluder is used to seal the lower cavity type. The entire procedure takes about 30 minutes. Although the structure of the case is quite complicated and many experts on the scene during the demonstration broadcast are very different, Professor Zheng Hong successfully completed the operation according to the established plan of his preoperative design.
After the operation, the experts asked Professor Zheng Hong why the whole operation process is so confident and confident? Professor Zheng Hong replied with a smile: "Because there is already a patient's heart specimen before surgery, its morphological structure is basically clear." It turned out that 3D printing "heart test" has become a powerful assistant and effective tool for Professor Zheng Hong in the treatment of complex cases. Zheng Hong said: " 3D printing technology will bring huge changes in the medical field, and even set off a revolution in the new medical industry! This will effectively promote medical technology innovation and bring more breakthroughs in the development of medical diagnosis and treatment technology. It also brings good opportunities for personalized medicine and “private ordering.†Currently, the types of medical devices used in hospitals are strictly limited. These models have many differences with the actual needs of patients. The surgeons are based on the operating table. The patient's lesions can be subjected to various strains and treatments according to their own understanding, such as tailoring the heart patch. Once the product is formed, it cannot be customized as needed (in specific cases), which is obviously related to the current technological environment and patient application. The demand is misplaced. 3D data technology has promoted the development of medical precision, and our other packages have not kept up. In fact, as long as the medical device raw materials are biocompatible, or as long as the raw materials are the same, the shape and size The better with the patient's lesions, this is a change that 3D data medical services bring to us, that is, personalized customization becomes Maybe. And this is already a routine means in the field of dental medicine."
Figure 5. The patient walked to the ground on the second day after surgery and took a group photo with the surgeon.
The road to innovation has always been uneven, and people who walk on the road often experience the inevitable loneliness. "The birth of a technology, there must always be someone to try bravely. It is a good thing to have doubts. He will make us go more stable and perfect." The chubby Professor Zheng Hong does not care much about the disagreement or contempt of others. Just like on March 18th, after the unusual operation, he sat on the chair in front of the monitor with one leg, as usual, paying attention to the patient's postoperative indicators. Behind him was a person from the hospital. Towards, the doctors and nurses were rushing in a hurry, and the voice was noisy and busy. When someone came over and asked about the operation just now, he turned his head and said something to the person, then he still stared at the screen cheerfully, or picked up the heart test. The model looked and looked, baby like.
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