A minimally invasive alternative for the treatment of nutcracker syndrome using individualized three-dimensional printed extravascular titanium stents

作     者：He Wang Yi-Tong Guo Yong Jiao Da-Li He Bin Wu Li-Jun Yuan Yan-Yan Li Yong Yang Tie-Sheng Cao Bo Zhang Wang He;Guo Yi-Tong;Jiao Yong;He Da-Li;Wu Bin;Yuan Li-Jun;Li Yan-Yan;Yang Yong;Cao Tie-Sheng;Zhang Bo

作者机构：Department of UrologyTangdu HospitalThe Fourth Military Medical UniversityXi'anShaanxi 710038China Department of Ultrasound DiagnosisTangdu HospitalThe Fourth Military Medical UniversityXi'anShaanxi 710038 China 3D Printing Research Center of The Fourth Military Medical UniversityXi'anShaanxi 710038China Department of RadiologyTangdu HospitalThe Fourth Military Medical UniversityXi'anShaanxi 710038China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2019年第132卷第12期

页      面：1454-1460页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Nutcracker syndrome Extravascular stent Three-dimensional printing Titanium Minimally invasive Laparoscopy 

摘      要：Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.