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术前为什么要做模拟预演？
有患者会问，我的手术可以提前预演一次吗？
以前这个问题有人会觉得不可能，手术如何能够预演呢？但随着现代技术的进步，模拟医学正在成为现实。
其背后的根本原因在于：医疗安全。为了安全，模拟医学正在从“最佳秘诀”变成“最佳实践”。模拟医学主要借助模体和数字技术，以及衍生的模拟技术和模拟工具（模拟人和模拟器），进行人体教学、医学操作技术训练、手术设计，疾病预测与康复，以及指导新器械研发、新药研制。模拟医学正在快速发展中，正在从医学教育、急救培训、手术训练拓展到个性化医疗，从单纯训练到为医疗安全而进行的模拟预演，Rehearsal。未来在实际患者进行操作之前可能需要在模拟设备上操作一次。
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动脉瘤术前可以做模拟手术吗？
可以。
模拟手术，只是模拟，并非真实，但却需要尽可能呈现具体病例的特点，以及手术中可能遇到的关键点，进行模拟操作发现可能出现的问题，寻找最佳方案，以便实际手术中的完美复现，实现最佳疗效。
1、动脉瘤病例的真实复现
EPS模型是按照实际动脉瘤病例数据1:1地通过3D打印机打印出的血管模型，完美呈现动脉瘤的几何特征。整体成型后产品具有血管内壁光滑、血管结构完整呈现的特点，可以透过血管外壁清楚观察微导管在血管内走行路线及微导管状态。模型可精确呈现直径1mm以内的细微结构，颜色透明，透光率达99%以上。分为中空血管模型与实体模型，与原始血管结构无差异。
3D血管模型
2、微导管的最佳塑形策略
微导管的塑形是动脉瘤介入栓塞关键一步，最佳塑形形态是什么呢？在模型上通过真实的模拟到位操作可找出最佳微导管形态。以下为一例后交通动脉瘤，入射角为锐角，通过模拟操作确定微导管的最佳塑形方案。
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微导管模拟到位
3、动脉瘤模型病例上的模拟弹簧圈栓塞术
在3D打印出中空血管1:1动脉瘤模型上，在颅内动脉血管介入手术模拟台上进行介入操作：导引导管到位、微导管选择性进入动脉瘤体内，之后释放弹簧圈进行成篮，观察成篮效果，同时观察操作的难度及可能遇到的困难，并在实际手术中有针对性地处理、规避，保证手术的顺利实施，确定最优弹簧圈选择方案。
模拟弹簧圈栓塞术
4、动脉瘤数字模型上的支架植入与弹簧圈栓塞术
数字模拟是另一种策略。包括支架的术前模拟和弹簧圈释放模拟，以及二者的结合。支架数字模拟能明显增加手术成功率，减少并发症发生率。利用FEA技术模拟弹簧圈在动脉瘤体内的释放过程，真实还原血流动力学变化，有助于更准确地确定最优手术方案，减少复发，提高手术成功率。
科普结束
卢旺盛医院
医学博士
强联智创（北京）科技有限公司首席医学专家
神经外科副主任医师
声明：脑医汇旗下神外资讯、神介资讯、脑医咨询所发表内容之知识产权为脑医汇及主办方、原作者等相关权利人所有。未经许可，禁止进行转载、摘编、复制、裁切、录制等。经许可授权使用，亦须注明来源。欢迎转发、分享。
科普文章投稿请发送至邮箱help
medtion.
