3D虚拟内镜技术在输尿管软镜碎石术中的临床意义

The clinical value of 3D virtual endoscopy technology in ureteral soft lens lithotripsy in the treatment of kidney stones

目的探索在输尿管软镜下肾脏结石碎石中应用3D虚拟内镜技术是否能够提高碎石效率及安全性。方法 30例肾结石患者按住院号末位数字编号,单号设定为3D虚拟内镜组(试验组)、双号为常规影像学检查组(对照组)各15例,2组均应用64层螺旋CT对患者进行平扫+增强扫描,扫描结束后进行薄层重建。其中处理组提取患者CT检查结果的DICOM格式文件,使用Mimics软件进行3D图形后处理,然后获得患者肾脏集合系统的3D虚拟内镜模型。观察2组手术者确定目标盏的时间、第一次系统探查肾脏各盏的时间、拔除导尿管时间、下床活动时间以及清石率和并发症发生率。结果 30例手术均顺利完成,处理组肾脏3D虚拟内镜模型均成功建立,肾脏的集合系统、结石的大小和位置以及肾脏与结石的关系均显示良好。试验组确定目标盏时间、第一次系统探查肾盏时间均短于对照组,试验组清石率高于对照组,试验并发症(出血、感染等情况)发生率低于对照组(P<0.05),2组恢复时间(拔出导尿管、下床活动时间等)、住院时间差异无统计学意义。结论在输尿管软镜对肾脏结石碎石过程中,应用3D虚拟内镜技术,能够提高碎石效率,并且可以降低术后并发症。

Objective To investigate the application of 3D virtual endoscopy technology in kidney stone patients who accepted soft ureter mirror treatment and to further discuss whether it can improve the efficiency and security of lithotripsy. Methods The patients were divided into research group and control group randomly, according to the odevity of the last number of the ID number, the former using 3D virtual endoscopy and the latter using the conventional radiographic inspection. The 30 cases all accepted 64 layers spiral CT scan with non-and enhancement and thin layer were reconstructed after the scan. The CT results of research group were Stored by DICOM format file, which later treated by Mimics software in order to obtain the patients＇ kidney collecting system 3D models by 3D virtual endoscopy. The following parameters in 2 groups of surgical patients were observed： the time of the target, the first time the system to explore the time of the kidney, the time of removing the catheter, the time of getting out of bed and rate of stone clearance and incidence of complications. Results Thirty cases of surgery were completed successfully. The 3D virtual endoscopy models of 15 patients in research group were successfully established, which showed clearly images in the kidney collecting system, the size and the location of the stone, location and the good relationship between kidney and stone. The time to determine the target kidney calices and the first time to detect every kidney calices were less in 3D virtual endoscopy models. The remov!ng stone rate and the postoperative complications were significantly superior to the conventional radiographic inspection group （P〈0.05）.There is no statistically significant difference in recovery time （such as urethral catheter time, postoperative activity time, etc） and days of hospitalization. Conclusion The applieation of 3D virtual endoscopy techniques can improve the efficiency of gravel and reduce postoperative complications in the process of using soft ureter mirror in kidney stone patients.