Objective: To make three-dimensional prototyped models of nasal cavities and paranasal sinuses for endoscopic skills training and teaching and to verify and evaluate the fidelity of the models. Methods: Imaging data of a patient with nasal septum deviation was selected for prototyping the nasal cavities model, and the imaging data of a patient with chronic rhinosinusitis who underwent the endoscopic sinus surgery 4 months ago was selected for the paranasal sinuses model. Both patients came from the Department of Rhinology, the First Affiliated Hospital of Zhengzhou University. The models were printed by the desktop-level printer based on the fused deposition modeling (FDM). The evaluations of anatomical structures and prespecified tasks on the simulators were completed by 5 residents and 5 experts of Rhinology.The models were evaluated by survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated.Mann-Whitney nonparametric test was used to assess the differences between experts and residents groups. The statistical significance level was set at P<0.05. Results: All the components of the two models were prototyped in 24 h. For the nasal cavities model, the scores of each anatomical structure were more than 4.0. As to the paranasal sinuses model, except for the frontal sinus (3.6), the scores of each anatomical structure were more than 4.0. All the participants who performed the prespecified tasks evaluated the models well (>4.0). With the nasal cavity simulator, the experts completed the tasks (nasal cavity and nasopharyngeal endoscopy, removal of nasal foreign body, nasal packing, pledget insertion), and the other tasks (the nasal cavity and nasopharyngeal endoscopy, identification of ostiums of paranasal sinuses, maxillary sinus debridement with 70° nasal endoscopy) were completed with paranasal sinus model. The average time to complete each task by experts group and residents group (M (P(25), P(75))) were 10.3 (10.0, 10.7) s vs 17.1 (14.6, 20.7) s, 2.1 (2.0, 2.2) s vs 3.4 (2.6, 4.7) s, 30.1 (27.8, 32.8) s vs 59.2 (52.0, 65.4) s, 54.8 (50.1, 63.2) s vs 92.2 (79.3, 106.9) s, 9.3 (8.7, 9.9) s vs 14.5 (13.3, 14.9) s, 20.1 (19.3, 21.2) s vs 41.9 (35.5, 45.1) s, 31.1 (28.8, 35.2) s vs 52.8 (47.7, 56.3) s, respectively, and the average time to complete each task was shorter for the experts group than for the residents (U value was 0, 1.000, 0, 0, 0, 0, 0, respectively, all P<0.05). Conclusion: The models of nasal cavities and paranasal sinuses made by our desktop-level FDM 3D-printer are useful for endoscopic training skills.
目的： 利用3D打印技术制作可供鼻内镜训练教学的鼻腔鼻窦仿真模型，并进行检验与评估。 方法： 于郑州大学第一附属医院鼻科选取1例鼻中隔偏曲患者的术前CT数据建立鼻腔模型；选取1例慢性鼻－鼻窦炎患者接受双侧全组鼻窦开放术及鼻中隔成形术后4个月随访时的CT数据建立鼻窦模型。应用自主研发的桌面级熔融沉积成型(fused deposition modeling，FDM)打印机分别制作鼻腔与鼻窦模型后，由专家组和住院医师组各5名医师对模型进行检验。专家组以5分李克特量表评价模型鼻内镜下解剖结构的仿真性和训练鼻内镜基本操作的实用性；专家组和住院医师组分别在模型上进行双侧鼻内镜基本操作，计时并进行比较。组间操作时间比较采用Mann－Whitney检验，将P<0.05设为差异有统计学意义。 结果： 模型所有组件均在24 h内打印完成。鼻腔模型各解剖结构的仿真程度平均评分均>4.0分，鼻窦模型仿真程度平均评分除额窦为3.6分外，其余诸解剖结构均>4.0分。两个模型的各项鼻内镜下基本操作实用性的平均评分均>4.0分。在鼻腔模型上完成鼻腔及鼻咽部探查、圆球形异物取出、填塞凡士林纱条、放置棉片表面麻醉；在鼻窦模型上完成鼻腔及鼻咽部探查、鼻窦开口辨认、70°鼻内镜下双侧上颌窦换药各项操作，专家组和住院医师组在上述操作中用时的中位数、25分位数和75分位数(M[P(25)，P(75)])分别为：10.3[10.0，10.7]s比17.1[14.6，20.7]s、2.1[2.0，2.2]s比3.4[2.6，4.7]s、30.1[27.8，32.8]s比59.2[52.0，65.4]s、54.8[50.1，63.2]s比92.2[79.3，106.9]s、9.3[8.7，9.9]s比14.5[13.3，14.9]s、20.1[19.3，21.2]s比41.9[35.5，45.1]s、31.1[28.8，35.2]s比52.8[47.7，56.3]s，专家组在模型上完成基本操作的时间较住院医师组更短(U值分别为0、1.000、0、0、0、0、0，P值均<0.05)。 结论： 桌面级的FDM打印机制作的3D鼻腔和鼻窦模型检验结果满意，可用于鼻内镜基本操作的训练与教学。.
Keywords: Endoscopes; Imaging, three-dimensional; Models, structural; Nasal cavity; Paranasal sinuses.