3D打印技术在经皮肾镜取石术术前规划及医患沟通中的应用研究

Application of 3D-printing technology in preoperative planning and doctor-patient consultation of percutaneous nephrolithotomy

目的 探讨3D打印技术制作的结石模型在经皮肾镜取石术（PCNL）中的应用及其在医患沟通中的作用.方法 选取2015年4-6月收治的15例行PCNL的手术患者.结石位于左肾5例,右肾10例;单发结石4例,多发结石9例,鹿角形结石2例;CT检查示结石大小为0.6-3.9 cm,平均2.1 cm.提取患者的CT平扫检查结果,使用三维影像学软件进行处理,人工去除结石周围的肾组织及肾周脂肪组织等,保留同侧第12肋组织,以光敏树脂制作3D肾结石模型.请5名手术医师于术前根据3D打印结石模型及影像学检查资料设计手术方案,术后填写针对手术医师设计的模型评估调查问卷,以评估该模型的真实性及实用性.使用3D打印结石模型之前需与患者及家属进行术前谈话,并请患者及家属填写3D打印结石模型调查问卷并评分.结果 成功打印出15例患者的3D结石模型,该模型明确反映出结石大小、形状及与第12肋的关系.使用3D打印结石模型预估的穿刺点及穿刺肾盏与实际手术基本符合,预估的穿刺深度为（5.7±0.6） cm,实际穿刺深度为（6.2±0.7） cm,两者差异无统计学意义（P=2.04）.手术医师对3D结石模型的总体评价得分为（7.5±0.5）分,患者及家属对使用3D结石模型的术前谈话的总体满意度得分为（8.7±0.8）分.结论 3D打印的结石模型能够良好地反映出结石与周围组织的关系,并在PCNL术前规划及手术过程中起到一定的作用,同时可以作为PCNL术前医患沟通的有效工具.

Objective To discuss the applications of 3D-printing technology in percutaneous nephrolithotomy （PCNL） and its function in preoperative consultation.Methods Fifteen patients of renal calculus in Tongji Hospital from April to June 2015 were selected in the present study.The preoperative CT scan of renal was processed by three-dimensional radiological software,the renal tissue and perirenal fat were deleted but the 12th rib was left with the renal calculi by the software,and the final models were made by photosensitive resin.Virtual operation based on the 3D-printed model of renal calculi and preoperative data were made preoperatively and compared with actual operation.The efficacy of the models in preoperative planning was evaluated.Operators were asked to fill the questionnaire after operation in order to investigate the efficacy of the renal calculi printed by 3D-printing technology in PCNL.By using the models in consultation before operation,the patients and their family members were asked to fill questionnaires and the efficacy of the models in doctor-patient communication was also evaluated.Results The 15 3D-printed models of renal calculi were set up well and all the operations were successful.The models clearly reflected the size and shape of the renal calculi and the position of the renal calculi and the 12th rib.The virtual puncture point and the renal calyx of puncture were basically corresponded to the actual operation,the puncture depth of virtual operations was （5.7 ± 0.6） cm,while the puncture depth of actual operations was （6.2 ± 0.7） cm,and there was no significant difference （P =2.04）.The average evaluation score of the models given by operators was 7.5 ± 0.5,and the average score of the doctor-patient conversation before operation given by the patients or their family members was 8.7 ± 0.8.Conclusions The renal calculi models printed by 3D-printing technology can clearly reflect the size and shape of renal calculi,and the models also play a very important role in preoperative planning and operative process.Meanwhile,the models could be useful in the doctor-patient consultation.