Mr Wang began to suffer from waist pain four years ago. He went to several local hospitals and was told that he had a herniated lumbar disc. Tried a variety of treatments, the pain has not been significantly improved, and the condition gradually aggravated. Recently, he had perineal pain and difficulty in defecation, so he came to the Department of Bone Disease and Bone Oncology of Yantaishan Hospital recently. After improving the relevant examination, the outpatient doctor informed Mr. Wang that the possibility of sacral chordoma was relatively high, and it was recommended to perform biopsy first to determine the nature of the tumor. After hospitalization, the patient was pathologically confirmed as chordoma by puncture.

The lesion was large, measuring 12 cm ×9 cm, and destroyed not only the sacrum bone, but also the gluteus maximus muscle. In addition, the anatomical location is deep, the surrounding structure is complex, the tumor is rich in blood supply, and the surgical exposure is difficult, which brings great challenges to the resection. The team of President Chang Liming and Director Liao Guangjun organized case discussion in the department for many times, and formulated various detailed surgical methods, including intestinal resection + rectostomy, flap transplantation and other alternative surgical plans. At the same time, the 3D printing technology is used to 3D print the sacral model at a 1:1 ratio according to the preoperative imaging data of patients, which helps the surgeon to understand and master the tumor boundary and invasion degree more clearly, so as to make preoperative planning and optimize the surgical plan, and provide tactile and visual experience for patients, their families and surgeons. To help operators communicate with patients and their families more effectively before surgery.

Maximum benefit for patients at minimum cost

President Chang Liming introduced that chordoma is a low-grade malignant tumor, not sensitive to chemoradiotherapy, surgical resection is the first choice of treatment. But there are two big problems with surgery: First, the bleeding problem. Although there are many surgical methods for sacral malignant tumors, due to the extremely rich local blood supply, there is a risk of excessive blood loss and even shock death during the operation, so many hospitals do not carry out this kind of surgery. Second, the problem of urination and sexual function. One of the major problems affecting quality of life after sacral tumor resection is urinary and bowel dysfunction and sexual dysfunction. Generally speaking, small tumors in the low position are easy to remove without nerve damage, while larger tumors in the high position are difficult to remove without nerve damage. In order to ensure that the patient's urine and stool function and sexual function are not affected, at least one side of the sacral 3 nerve root should be preserved, while the nerve root above sacral 2 is normal. When one side of the sacral nerve is completely severed and the other side is normal, 90% of patients have normal bowel and urine function and sexual function. In addition, the tumor grows close to the rectum and is adhesive to the rectum, which is likely to lead to rectal rupture when the tumor is removed during the operation, and then lead to incision infection, and rectal fistula and severe and stubborn septic shock after the operation.

Preoperative has been fully communicated with patients and their families, patients and their families also agreed to remove the tumor at the cost of defecation and urine function, but the doctor is benevolent, Chang Liming president, Liao Guangjun director team still decided to let patients get the maximum benefit at the minimum cost.

After 3 hours, the bomb was completely removed.

Before operation, the interventional department helped embolize the tumor, nourish the blood vessels and place the abdominal aortic balloon. Under escort anaesthesia, blood transfusion branch, often dawn the dean, director of the Liao Guangjun team in using 3 d printing model, clear the scope of malignant tumor of soft tissue, bone destruction, the location of the need to cut bone, etc., to reduce the use of intraoperative X-ray fluoroscopy, simplifies the operation steps, reduce intraoperative blood loss, complex bone tumors surgery become relatively easy, In the end, the operation was successfully completed after 3 hours and 2000 ml of blood loss. After the operation, Mr. Wang's left sacral 3 and above nerves were preserved, the urine and feces function was not damaged, and the incision healed well. Mr. Wang is very satisfied with the results of the operation and has been discharged from hospital smoothly.

Director Liao Guangjun reminded the majority of patients, lumbosacral, thigh pain in addition to common lumbar disc herniation, lumbar muscle strain, sacral fasciitis and other reasons, but also need to exclude the possibility caused by pelvic and sacral lesions. It is suggested that once these abnormalities are found, we should seek the diagnosis and treatment of specialist doctors, and emphasize again the principle of early detection, early treatment and early prevention of malignant tumors.

About the Medical 3D Printing Innovation Research Center of Yantai Mountain Hospital

In the big situation of "combination of medicine and industry", the Medical 3D printing Innovation Research Center of Yantai Mountain Hospital is the first medical 3D printing innovation research center in Yantai City. It was jointly founded by Yantai Mountain Hospital and the Clinical Transformation Research and Development Center of 3D printing technology of the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, and was established in October 2021. Center has 3 d plate, printing laboratory model, prosthetic implant, such as experiment laboratory, mainly through the research of medical imaging, processing, modeling, augmented reality technology, using computer digital technology assisted surgery planning and the clinical application of 3 d printing technology, with a new scientific idea, a solid theoretical basis, advanced diagnosis mode, It can be widely used in clinical medicine with more accurate diagnosis and treatment. Since the establishment of the 3D Printing Innovation Research Center, it has made many breakthroughs in multiple disciplines and fields, and won the second prize in the national 3D printing Innovation competition. 3D Printing Innovation Research Center of Yantaishan Hospital has been adhering to the concept of "scientific and technological innovation and people-oriented". Under the strong support of Academician Dai Kyorong of Shanghai Ninth Hospital and Binzhou Medical College, the center has been constantly increasing the investment in scientific research and striving to benefit patients with more scientific research achievements.