基于CT的肾结石三维模型在经皮肾镜中的应用

The application of the renal calculus 3D model based on CT in percutameous nephrolithotomg

目的探讨基于CT的肾结石三维模型在经皮肾镜碎石取石术(PCNL)中的应用。方法选取深圳市宝安区人民医院泌尿外科2016年7月至9月收治的12例临床确诊为肾结石并拟行PCNL手术的患者临床资料,男6例,女6例,其中右肾结石7例,左肾结石5例,年龄28~46岁,平均39岁。CT提示结石最大径为2.3~4.2 cm,平均3.2 cm。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。由4名手术医师于术前根据3D肾结石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模型评估调查问卷,以评估该3D模型的有效性。以3D肾结石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结石模型评估调查问卷。结果成功重建出12例患者的3D肾结石模型,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。术前利用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与实际手术基本符合,预估的穿刺深度为(6.6±0.8)cm,实际穿刺深度为(7.1±0.7)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(8.5±0.6)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(8.4±0.7)分。结论基于CT的3D肾结石模型能够很好地反映肾结石的大小、位置以及肾脏与周边脏器的关系,在PCNL术前规划中起到积极的作用,同时可作为PCNL术前医患沟通的有效工具。

Objective To explore the application of the renal calculus 3D model based on CT in percutameous nephrolithotomg（PCNL）. Methods From July 2016 to September 2016, twelve patients were diagnosed with renal calculus and underwent PCNL in Shenzhen Baoan District People＇s Hospital. The mean age was 39（range： 28-46） years old. Among them, there were 5 patients with left renal calculus and 7 patients with right renal calculus. The maximum diameter of the renal calculus was between 2.3 to 4.2 cm, and the mean diameter was 3.2 cm according to the CT scan. The CT image data collected from these patients would be divided and rebuilt its 3D model by using the 3D rebuilding software MIMICS 17.0, to build a personalized 3D model of the renal calculus. Before the surgery, 4 surgeons would design a specific surgery strategy 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 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 3D renal calculus model was used as a tool for communication before the surgery, and they were invited to fill the appraisal questionnaire. Results The 3D renal 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（6.6±0.8） cm, while the puncture depth of actual operations was（7.1±0.7） cm, and there was no significant difference（P〈0.05）. The mean evaluation score of the models given by surgeons was（8.5±0.6）. And the mean score of the doctor-patient conversation before operation given by the patients or their family members was（8.4±0.7）. Conclusions The 3D renal calculus models based on CT can clearly reflect not only the size and location of renal calculus, but also the relationship between the kidney and adjacent anatomical structures.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.