基于彩色3D打印技术的肾结石个性化手术治疗

Personalized surgical treatment of kidney stones based on colour 3D printing technology

目的探究彩色3D打印技术在泌尿外科经皮肾镜碎石取石术（PCNL）中的应用及临床意义。方法随机选择16例彩色3D打印肾结石患者作为A组,利用逆向工程与彩色3D打印技术进行重建并备1：1大小完整的肾脏、肾血管及肾彩色结石3D模型。选取23例传统PCNL患者作为B组,观察比较A、B两组的手术时间、术中出血量、住院时间、并发症以及结石清除率。手术医师填写模型评估调查问卷,患方填写调查问卷并进行评分。结果成功打印出患者的彩色3D结石模型。纳入研究的两组患者年龄、结石大小、铸型结石量无统计学差异。两组的预估穿刺深度与实际穿刺深度分别为A组：（6.5±0.8）cm vs（6.8±1.1）cm（P〉0.05）;B组：（6.5±1.5）cm vs（7.6±1.8）cm（P〈0.05）。两组医师评分分别为（8.4±0.4）,（6.5±0.5）（P〈0.05）;患者评分分别为（9.0±0.7）,（7.2±0.6）（P〈0.05）。两组的结石清除率,手术时间,术中出血量,住院时间,并发症例数分别为：81.25%vs 73.91%（P〈0.05）,（52.27±9.64）min vs（67.39±10.81）min（P〈0.05）,（55.49±18.16）mL vs（92.92±22.17）ml（P〈0.05）,（6.48±1.51）d vs（7.32±1.43）d（P〉0.05）,1例vs 3例（P〈0.05）。这些结果提示使用彩色3D打印结石模型预估的穿刺点和穿刺深度与实际手术基本相符,出血量更少,手术时间更短、并发症更少。手术医师评价彩色3D打印结石模型满意,患方术前谈话满意度更高。结论彩色3D打印技术能够使泌尿外科医生在术前精确、直观地了解肾结石情况,较传统手术获得更高的精确性和安全性。使用彩色3D打印结石模型对患者进行病情讲解和术前谈话可以提高其对肾结石及手术并发症的理解,有利于构建良好的医患关系。

Objective To explore the application and clinical significance of colour 3 D printing technology in percutaneous nephrolithotomy lithotripsy（PCNL）. Methods Sixteen renal calculi patients with colour 3 D printing were selected randomly as group A. Reverse engineering and color 3 D printing were used to reconstruct and produce 1：1 colour 3 D models of kidneys, renal vascular and renal calculi. 23 cases of traditional PCNL were selected as B group. The surgical duration, the amount of bleeding, hospitalization length, the complications and the clearance rate of the two groups were observed and compared. The surgeons filled in the model to evaluate the questionnaire, and the patients filled in the questionnaire and scored.Results The patients＇ color 3 D stone models were successfully printed. There was no significant difference in age, stone size and casting stone volume between the two groups. The puncture depth of preoperative estimation and actual operative depth of the two groups were as follow： group A（6.5±0.8）cm vs（6.8±1.1）cm（P〉0.05）; group B：（ 6.5 ± 1.5）cm vs（7.6 ± 1.8）cm（P〈0.05）. The scores of the two groups of physicians were（8.4 ± 0.4）,（6.5 ± 0.5）（P〈0.05） respectively, and the patients＇ scores were（9 ± 0.7）,（7.2 ± 0.6）（P〈0.05）. The comparison of the two groups for stone clearance rate, the surgical duration, haemorrhage, hospitalization length, the number of complications were： 81.25% vs 73.91%（P〈0.05）,（52.27 ± 9.64）min vs（67.39 ± 10.81）min（P〈0.05）,（55.49 ± 18.16）m L vs（92.92 ± 22.17）m L（P〈0.05）,（6.48 ± 1.51）d vs（7.32 ± 1.43）d（P〉0.05）, 1 case vs 3 cases（P〈0.05）. Those results suggested that the punctures and depth of puncture predicted by the color 3 D lithiasis model were basically consistent with the actual operation, with less bleeding, shorter surgical duration and less complications. The surgeons were satisfied with the color 3 D printing lithiasis model, and the patients were satisfied with preoperation talk. Conclusion Colour 3 D printing technology enables urologists to accurately and intuitively understand the status of kidney stones before operation, guides the development of surgical plans and simulates surgical operations. The doctors gain higher accuracy and safety than traditional surgery.Using the colour 3 D printed stone model to explain the condition and preoperative conversation can improve the patients＇ sunderstanding of kidney stones and surgical complications, and help to build a good doctor-patient relationship.