探讨3D打印技术在腹腔镜胰十二指肠切除术（LPD）中的应用价值。

回顾性分析2015年11月至2017年3月云南省第一人民医院25例行3D打印技术辅助下LPD患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男17例，女8例；年龄31～75岁，中位年龄54岁。胰头癌13例，壶腹周围癌12例。术前三维重建、3D打印可视化模型，确定肿瘤位置及与血管关系，虚拟手术规划，术中3D实时引导行LPD。观察3D打印手术规划、手术、并发症及近期疗效。手术前后生活质量改善情况比较采用秩和检验。

25例患者均完成3D打印及虚拟手术规划。3D打印模型对患者胰腺、胰周大血管及病灶显示率为100%。通过多个手术方案的优化筛选确定最佳手术方案。25例患者均顺利完成LPD，无中转开腹。中位手术时间285（220～350）min，术中出血量450（100～800）ml。无发生围手术期死亡，无术后腹腔感染及出血。5例发生不同程度的胰瘘，其中A级胰瘘3例，B级胰瘘2例，均经非手术治疗治愈。随访3个月，患者均无肿瘤局部复发。术后6个月，患者生活质量良好、较好、一般、差分别为21、2、1、1例，术前相应为15、5、3、2例，术后生活质量明显改善（Z=41.600，P<0.05）。

3D打印技术可真实反映病灶与周围器官的空间关系，在术前诊断、解剖定位、虚拟手术以及指导术中实时操作有实际作用。

To explore the application value of 3D printing technology in laparoscopic pancreatoduodenectomy (LPD).

Clinical data of 25 patients undergoing LPD assisted by 3D printing technology in the First People's Hospital of Yunnan Province from November 2015 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 17 patients were male and 8 female, aged 31-75 years old with a median age of 54 years old. 13 cases were diagnosed with pancreatic head cancer and 12 cases of periampullary cancer. Preoperative 3D reconstruction was performed and visualization model was established by 3D printing to determine the relationship between tumor location and blood vessels. Surgical plan was virtualized. LPD was performed with intraoperative 3D real-time guidance. The planning, operation, complications and short-term efficacy 3D printing-assisted LPD were observed. The improvement of quality of life before and after operation was statistically compared by rank-sum test.

3D printing and virtual surgical planning were performed in all 25 patients. The 3D printing model yielded a detection rate of 100% for pancreas, peripancreatic vessels and lesions. The optimal surgical plan was determined after the optimization and screening of multiple surgical plans. All 25 patients successfully completed LPD without conversion to open surgery. The median operation time was 285(220-350) min and intraoperative blood loss was 450(100-800) ml. No perioperative death, postoperative abdominal infection or hemorrhage occurred. Pancreatic fistula of varying degree occurred in 5 cases including 3 cases of grade A pancreatic fistula and2 cases of grade B, all of which were cured by non-surgical therapies. During the 3-month follow-up, no local tumor recurrence was noted. At postoperative 6 months, 21 patients had excellent quality of life, 2 cases of good quality of life, 1 case of moderate quality of life and 1 case of poor quality of life, significantly improved comparing with 15, 5, 3 and 2 cases before operation (Z=41.600, P<0.05).

The 3D printing technology can objectively reflect the spatial relationship between lesions and surrounding organs, which plays a practical role in preoperative diagnosis, anatomical localization, virtual surgical planning and providing real-time guidance for intraoperative procedures.