3D打印技术对鹿角形肾结石PCNL术前精准设计的临床研究

Clinical study on three-dimensional printing for precise designing PCNL in staghorn renal stone

目的:探讨3D打印技术对鹿角形肾结石经皮肾镜取石术(PCNL)术前精准设计的临床应用以及在医患沟通中的作用。方法:选取2016年5月~2017年6月北京清华长庚医院泌尿外科收治拟行PCNL的63例鹿角形肾结石患者纳入研究。将63例患者随机分为3D打印组与常规影像检查组(对照组),两组术前均行CT平扫+增强(薄层重建)。处理组提取CT的DICOM文件进行3D图形后处理,采用热塑性材料打印获得3D模型。两组分别在术前、术中、术后三方面进行比较。术前:《术前谈话评分表》的得分情况。术中:(1)目标肾盏定位时间;(2)术前规划穿刺盏与术中实际穿刺盏的符合度;(3)手术完成时间。术后:(1)清石率;(2)术后并发症;(3)术后恢复情况。结果:成功打印出所有3D模型,肾脏血管、集合系统以及结石分布等均显示良好。手术均顺利完成。3D打印组在《术前谈话评分表》的得分情况、目标肾盏定位时间、模拟穿刺盏与实际穿刺盏的符合度以及术后清石率等方面优于对照组(P<0.05)。但两组在手术完成时间、术后并发症及术后恢复情况比较差异无统计学意义(P>0.05)。结论:3D打印模型能够很好地显示结石肾脏内部的位置关系,并可以有效帮助医生进行术前规划,提高手术效率,还可以用作与患者交流的工具,使医患沟通变得顺畅。

Objective：To explore the clinical application value as well as the role of doctor-patient communication of precise design for PCNL by using three-dimensional printing technology.Method：From May 2016 to June 2017,63 patients with staghorn kidney stones who underwent PCNL were selected in study,in accordance with the principle of randomization into its 3 Dprinting group and control group.All the patients underwent plain and enhanced scan with spiral CT in the two groups accompanying thin layer reconstruction after scanning.The DICOM format files of the CT test results were extracted from the treatment group,then they were post-processed in 3 Dgraphics.Three-dimensional models were obtained by using thermoplastic materials to print according to the 3 Dgraphics.The two groups were compared preoperatively,intraoperatively and postoperatively separately.Preoperation：Comparison in 《rating scale of preoperative conversation》.Intraoperation：（1）Time for confirming the target calyce,（2）Consistence of target calyces between preoperative designed puncture and intraoperative actual puncture,（3）Total surgery time.Postoperation：（1）Comparison of stone clearance rate,（2）Comparison of postoperative complications,（3）Postoperative recovery.Result：All renal 3 D models of treatment group were successfully printed.The blood vessels,collection system and stones were distinctly shown.Sixty-three cases of surgeries were completed successfully.Three-dimensional printing group was better than the conventional imaging examination group in scores of 《rating scale of pre-operative conversation》,time for confirming the target calyce,consistence of target calyces and stone clearance rate（P0.05）.There was no statistical significance in total surgery time,postoperative complications or postoperative recovery（P0.05）.Conclusion：Three-dimensional printing models can display the relationship between stones and kidney distinctly,so it can assist doctors to develop a surgery planning effectively and make the doctor-patient communication much more convenient as well.