3D打印技术在后腹腔镜下肾部分切除术中的应用研究

Application of 3D printing technology in retroperitoneal laparoscopic partial nephrectomy

目的探讨3D打印技术在后腹腔镜下肾部分切除术(RLPN)中的应用价值。方法选取2017年10月至2018年2月我院收治的20例拟行腹腔镜下肾部分切除术的肾肿瘤患者,按照入院顺序,采用随机数表法将患者分为观察组和对照组,每组各10例。提取观察组患者CT影像学数据,使用三维影像软件处理后进行3D打印制作患者患侧肾脏模型。术者应用3D打印肾脏模型与观察组患者进行术前病情沟通,并指导手术操作;应用传统CT胶片与对照组患者进行术前病情沟通,并指导手术操作。病情沟通后,对两组患者进行回答认知度评估。分析比较两组患者对疾病相关知识的认知程度,以及两组病例的手术时间、肾动脉阻断时间、术中出血量、胃肠道恢复时间、术后住院时间、术后病理结果及术后3个月随访患肾肾小球滤过率(GFR)下降值。结果观察组患者对疾病相关知识的认知程度较对照组显著提高,差异有统计学意义(P<0.05);观察组的手术时间、肾动脉阻断时间分别为(104.9±9.0)min、(23.4±2.7)min,较对照组的(118.0±10.9)min、(27.2±2.5)min,均明显缩短,差异有统计学意义(P<0.05);观察组患者术后3个月随访患肾GFR下降值为(10.07±4.91)ml/min,较对照组的(15.95±5.06)ml/min降低,差异有统计学意义(P<0.05);观察组的术中出血量、术后胃肠道恢复时间、术后住院时间、术后病理结果及切缘阳性率指标与对照组比较,差异无统计学意义(P>0.05)。结论 3D打印模型可提高患者对疾病的认知,用于指导手术可降低手术及肾动脉阻断时间,减少肾功能损伤,值得推荐。

Objective To investigate the value of 3D printing in retroperitoneal laparoscopic partial nephrectomy (RLPN). MethodsTwenty patients with renal tumor who underwent laparoscopic partial nephrectomy were enrolled in our hospital from October 2017 to February 2018. According to the order of admission, patients were divided into observation group and control group by random number table method, 10 cases in each group. The CT imaging data of the observation group patients were extracted, and the patient's affected kidney model was made by 3D printing after processing with 3D imaging software. The surgeon used the 3D printed kidney model to communicate with the observation group for preoperative disease and to guide the operation. The traditional CT film was used to communicate with the control group for preoperative condition and to guide the operation. Both groups of patients answered the recognition assessment questionnaire after the condition was communicated. The two groups of patients were statistically compared in the cognition of disease-related knowledge. The operation time, renal artery occlusion time, intraoperative blood loss, gastrointestinal recovery time, postoperative hospital stay and postoperative pathological results were compared between the two groups. Statistical analysis of the decline in renal glomerular filtration rate (GFR) was followed up for the last 3 months. ResultsThe cognition of disease-related knowledge in the observation group was significantly higher than that in the control group, and the difference was statistically significant ( P <0.05). The operation time and renal artery occlusion time in the observation group were (104.9±9.0) min,(23.4 ±2.7) min respectively, compared with the control group (118.0±10.9) min,(27.2±2.5) min, significantly shortened, the difference was statistically significant ( P <0.05). During the postoperative follow-up period of 3 months, decline in postoperative renal GFR in the observation group patients (10.07±4.91) ml/min was lower than that in the control group (15.95±5.06) ml/min, and the difference was statistically significant ( P <0.05). There was no significant difference in the amount of intraoperative blood loss, postoperative gastrointestinal recovery time, postoperative hospital stay, postoperative pathological results or positive margin index between the observation group and the control group ( P >0.05). ConclusionsThe 3D printing model can improve the patient's cognition of disease, and can reduce the time of surgery and renal artery occlusion and reduce renal function damage. It is worth recommending.