3D打印技术在经皮肾镜取石术中的应用

Application of 3D print technology in PCNL

目的:探讨3D打印技术在经皮肾镜取石术(PCNL)中的应用。方法:选取2016年3~6月收治的12例临床确诊为肾结石并拟行PCNL的患者,男6例,女6例;其中左肾结石7例,右肾结石5例;年龄24~52岁,平均42岁。CT提示结石最大径为1.8~3.9cm,平均2.8cm。采集肾结石患者的CT数据,利用三维重建软件MIMICS 17.0进行图像分割和三维重建,建立个性化肾结石三维模型。利用3D打印技术打印出包含肾段脊柱、第12肋、肾实质、结石、集合系统、肾动静脉的肾结石3D打印模型。由4名手术医师于术前根据3D肾结石打印模型结合影像学资料设计具体手术方案,术中记录实操数据,术后填写3D打印模型评估调查问卷,以评估该3D打印模型的有效性。以3D打印模型作为术前谈话工具,与患者及家属进行术前谈话,并请患者及家属填写3D打印模型评估调查问卷。结果:成功打印出12例患者的3D肾结石打印模型,该模型直观显示了肾结石的大小及位置,肾内集合系统和肾盂,肾动、静脉,以及肾周毗邻脏器的关系。使用3D肾结石模型预估的穿刺肾盏、穿刺点及是否需要双或多通道的选择与实际手术基本符合,预估的穿刺深度为(6.7±0.7)cm,实际穿刺深度为(7.1±0.5)cm,两者差异无统计学意义(P>0.05)。手术医师对3D结石模型的总体评价得分为(8.3±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(7.8±0.8)分。结论:3D打印的肾结石模型能够很好地反映出结石形态、位置及与周围组织的关系,在定制PCNL术前方案中起到一定的作用,同时可作为PCNL术前与患者沟通的有效工具。

Objective：To explore the application of 3Dprint technology in PCNL.Method：There were 12 renal calculus patients who were confirmed and prepared to perform PCNL surgery from March to June,2016,including six males and six females.Their mean age was 42（range,24-52）years old.Among them,there were seven left renal calculus patients and five right renal calculus patients.The maximum diameter of the renal calculus of these patients was all between 1.8to 3.9cm and the mean diameter was 2.8cm according to the CT report.The CT image data collected from these patients would be divided and rebuilt its 3D model by using the 3Drebuilding software MIMICS 17.0so as to build a personalized 3Dmodel of the renal calculus.We used the 3Dprint technology to print the 3Drenal calculus including the renal spine,12 th rib,renal parenchyma,renal calculus,collecting system,renal artery and vein model.Before the surgery,four surgeons would design a specific surgery plan according to the 3D model of the renal calculus and combine it with the iconography materials.During the surgery,they would record the practical operating data,and fill up the appraisal questionnaire of the 3D models after the surgery to appraise the availability of the 3D model.As for the patients and their families,the 3Drenal calculus model was used as a tool for communication before the surgery and to invite them to fill up the appraisal questionnaire.Result：The 3Drenal calculus models of these 12 patients were successfully constructed.The models clearly showed the size and location of the renal calculus,the inner renal collecting system,renal pelvis,vein and the interrelationship with the adjacent anatomical structures.The virtual puncture point and the renal calyx of puncture were basically corresponded to the actual operation.The puncture depth of virtual operations was（6.7±0.7）cm,while the puncture depth of actual operations was（7.1±0.5）cm,and there was no significant difference（P0.05）.The average evaluation score of the models given by operators was（8.3±0.5）.And the average score of the doctor-patient conversation before operation given by the patients or their family members was（7.8±0.8）.Conclusion：The renal calculi models printed by 3D-printing technology can not only clearly reflect the size and shape of renal calculi,but also play a very important role in preoperative planning and operative process.Meanwhile,the models could be useful in the doctor-patient consultation.