基于3D打印辅助复杂性肛瘘精细化治疗

Refined Treatment of Complex Anal Fistula Assisted by 3D Printing

摘要: 目的：本研究旨在探讨基于MRI的3D打印技术构建肛瘘实体模型在术前评估及手术导航中的应用价值。方法：本研究在郴州市第一人民医院招募48例复杂性肛瘘患者(实验组与对照组各24例)。实验组患者签署知情同意书后，采用3.0T MRI扫描(T2WI脂肪抑制、T1WI平扫及增强序列)，获取高分辨率DICOM数据。通过Mimics软件进行三维重建，逐层勾画肛管及瘘管走形，生成STL格式模型并3D打印。打印模型用于手术路径规划，对照组数据来自医院电子病历系统。术后评估指标包括肛瘘内口、瘘管、脓肿的检出率以及手术时间，以验证3D打印模型的临床辅助价值。结果：3D打印模型辅助手术组术后引流创口显著小于对照组(1.5 ± 0.5 cm vs. 4 ± 1 cm, P < 0.05)，肉芽组织形态评分更低(1.0 ± 0.3 vs. 2 ± 1, P < 0.05)，提示创面愈合更优。Wexner评分显示，实验组肛门功能损伤更轻(1.2 ± 0.8 vs. 4.5 ± 2.3, P < 0.05)，证实3D模型可减少括约肌损伤。结论：基于MRI的3D打印模型能精准呈现肛瘘立体解剖，优化手术路径规划。该技术为复杂性肛瘘的精准治疗提供了可靠支持，具有临床推广价值。

Abstract: Objective: This study aims to investigate the application value of MRI-based 3D printing technology in constructing physical models of anal fistulas for preoperative assessment and surgical navigation. Methods: Forty-eight patients with complex anal fistulas were recruited at The First People’s Hospital of Chenzhou (24 in the experimental group and 24 in the control group). After signing informed consent, patients in the experimental group underwent 3.0T MRI scanning (T2WI fat-suppressed, T1WI plain and contrast-enhanced sequences) to acquire high-resolution DICOM data. Three-dimensional reconstruction was performed using Mimics software, with the anal canal and fistula tract outlined layer by layer to generate STL format models, which were then 3D printed. The printed models were used for surgical path planning, while data for the control group were obtained from the hospital’s electronic medical records. Postoperative evaluation indicators included the detection rate of the internal opening, fistula tract, and abscess, as well as operative time, to verify the clinical auxiliary value of the 3D-printed models. Results: In the 3D-printed model-assisted surgery group, the postoperative drainage wound was significantly smaller than that in the control group (1.5 ± 0.5 cm vs. 4 ± 1 cm, P < 0.05), and the granulation tissue morphology score was lower (1.0 ± 0.3 vs. 2 ± 1, P < 0.05), indicating better wound healing. The Wexner score showed that anal function impairment was milder in the experimental group (1.2 ± 0.8 vs. 4.5 ± 2.3, P < 0.05), confirming that the 3D model can reduce sphincter injury. Conclusion: MRI-based 3D-printed models can accurately display the three-dimensional anatomy of anal fistulas and optimize surgical path planning. This technology provides reliable support for the precise treatment of complex anal fistulas and holds value for clinical promotion.