3D打印技术在复杂肾结石患者经皮肾镜取石术中的应用

Application of 3D printing technique in percutaneous nephrolithotomy of patients with complicated kidney stones

目的探讨3D打印技术在复杂肾结石患者经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)中的应用研究。方法选取2015年1月至2017年12月河北北方学院附属第一医院收治60例复杂肾结石患者进行前瞻性研究,均拟行PCNL。将60例患者随机分为3D打印组(30例)与常规影像检查组(对照组30例),两组术前均采用泌尿系统造影(CT urography,CTU)检查,3D打印组提取CT的医学数字成像和通信(digital imaging and communications in medicine,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,根据3D肾脏模型的综合规划,为每位患者建立一个虚拟的安全可靠的经皮肾通路后执行PCNL。两组患者分别在术前、术中、术后三方面进行比较。术前:年龄、性别、体质量指数、血肌酐、结石大小及结石CT值。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)术后血红蛋白下降水平;(3)术后恢复情况。结果60例患者均顺利完成手术,30例患者成功打印出3D模型,能准确地表示结石与邻近解剖结构、肾内动脉和集合系统之间的相互关系。3D打印组在目标肾盏定位时间[(2.9±1.5)min与(5.8±1.7)min,P=0.023]、模拟穿刺盏与实际穿刺盏的符合[(89.5±3.5)%与(60.2±5.7)%,P=0.005)、术后清石率[(89.9±4.5)%与(75.9±5.2)%,P=0.009]及血红蛋白下降水平[(1.4±0.5)g/L与(2.9±1.4)g/L,P=0.032]优于对照组,差异均有统计学意义。但两组在手术完成时间及术后恢复情况比较,差异均无统计学意义(P均>0.05)。结论3D打印的肾脏模型真实还原了肾脏及结石周围的解剖结构,为医师提供了立体直观的方式进行手术,对于经皮肾镜取石术有指导意义。

Objective To investigate the application of 3D printing technique in percutaneous nephrolithotomy(PCNL)of patients with complicated kidney stones.Methods From January 2015 to December 2017,60 patients with complicated kidney stones were enrolled in the First Affiliated Hospital of Hebei North University for prospective study,and PCNL was proposed.All the patients were randomly divided into 3D print group(30 cases)and conventional image inspection group(30 cases,control group).Before operation,CT urography(CTU)was used in both groups.In 3D printing group,digital imaging and communications in medicine(DICOM)files of CT were extracted for 3D image postprocessing,and thermoplastic materials were used to print 3D model.In the 3D printing group,the digital imaging and communications in medicine(DICOM)files of CT were extracted for 3D image post-processing,and the 3D model was printed with thermoplastic materials.According to the comprehensive planning of 3D kidney model,a virtual safe and reliable percutaneous renal access was established for each patient,and PCNL was executed.The patients in the two groups were compared before,during and after operation.Preoperative:age,sex,body mass index,blood creatinine,stone size and CT value.During the operation:(1)the target renal calices location time;(2)the conformity between the preoperative planning and the actual operation;(3)the operation completion time.After operation:(1)stone removal rate;(2)hemoglobin reduction level;(3)postoperative recovery.Results All the 60 patients successfully completed the operation,30 patients successfully printed out the 3D model,which can accurately express the relationship between the stone and the adjacent anatomical structure,the internal renal artery and the collecting system.Positioning time of 3D printing group in target renal calices((2.9±1.5)min vs.(5.8±1.7)min,P=0.023),coincidence between simulated and actual puncture calices((89.5±3.5)%vs.(60.2±5.7)%,P=0.005),postoperative stone removal rate((89.9±4.5)%vs.(75.9±5.2)%,P=0.009),and hemoglobin levels((1.4±0.5)g/L vs.(2.9±1.4)g/L,P=0.032)were superior to the control group,and the difference was statistically significant.But there was no significant difference between the two groups(all P>0.05).Conclusion The 3D printed kidney model truly restores the anatomical details around the kidneys and stones,providing a stereoscopic and intuitive way to perform surgery,so it maybe has a significance guidance for percutaneous nephrolithotomy.