肾脏incool-3D立体影像技术在复杂肾结石经皮肾镜碎石取石术中的应用:前瞻性随机对照研究

Application of Incool-3D Stereoscopic Imaging Technique in Percutaneous Nephrolithotomy for Patients With Complicated Renal Stones:a Prospective Randomized Controlled Study

目的探讨incool-3D立体影像技术在复杂肾结石经皮肾镜碎石取石术前规划和术中的应用价值。方法选取我院2018年6月~2019年12月复杂性肾结石36例,随机分为incool-3D立体影像组和对照组各18例,incool-3D立体影像组依据3D立体影像图像和视频进行术前规划和术中应用,对照组依据术前KUB和CTU进行术前规划和术中应用。比较2组PCNL手术前预估和实际术中穿刺点和穿刺目标肾盏的吻合度、穿刺目标肾盏时间、手术时间、结石清除率、术后出血量、术后感染、引流管拔除时间和住院时间。结果incool-3D立体影像的建立可以显示肾脏集合系统的三维立体结构、肾脏的血管分布情况以及肾结石与周围毗邻的关系。incool-3D立体影像组术前谈话的各项评分均显著高于对照组(P<0.05)。incool-3D立体影像组术前预估和实际术中穿刺点及穿刺目标肾盏的吻合度分别为88.9%(16/18)和94.4%(17/18),明显高于对照组55.6%(10/18)和61.1%(11/18)(Fisher精确检验,P=0.020,P=0.030);incool-3D立体影像组术中穿刺目标肾盏时间、手术时间和清石率分别为(3.8±1.5)、(92.3±6.1)min和94.4%(17/18),对照组分别为(6.1±1.1)、(99.1±6.3)min和66.7%(12/18),差异有统计学意义(t=5.311,P=0.000;t=3.284,P=0.002;Fisher精确检验,P=0.044)。2组术后出血、术后感染发生率、引流管拔除时间和住院时间差异无统计学意义(P>0.05)。结论incool-3D立体影像能清楚显示肾脏的三维立体结构以及结石与周围毗邻的关系,可加强医患交流,提高手术效率,可在复杂性肾结石PCNL术中推广应用。

Objective To investigate the application value of incool-3D stereoscopic imaging technique in percutaneous nephrolithotomy(PCNL)for patients with complicated renal stones.Methods A total of 36 patients with complicated renal stones who underwent PCNL in our hospital between June 2018 and December 2019 were randomly divided into two groups(incool-3D stereoscopic imaging technique group and control group)with 18 cases in each group.The incool-3D stereoscopic imaging technique group underwent preoperative planning and intraoperative application according to 3D stereoscopic images and videos,and the control group underwent preoperative planning and intraoperative application according to preoperative KUB and computed tomography urography.The data of two groups in intraoperation and postoperation(consistence of target calyces between preoperatived designed puncture and intrope-rative actual puncture,time of puncturing the target calyces,operation time,stone clearance rate,blood loss,postoperative infection,drainage tube removal time,hospitalization time)were compared.Results Incool-3D imgaes clearly showed 3D renal collecting system,renal blood vessels and stones.The scores of questionnaries in the incool-3D group were better than those in the control group(P<0.05).Consistence of puncture point and target calyces in the incool-3D group between preoperatively designed puncture and intraoperative actual puncture was 88.9%(16/18)and 94.4%(17/18),which were significantly higher than 55.6%(10/18)and 61.1%(11/18)in the control group(Fisher’s exact test,P=0.020,P=0.030).Time of puncturing the target calcyce,operation time and stone clearance rate in the incool-3D group were(3.8±1.5)min,(92.3±6.1)min,and 94.4%(17/18),respectively,and they were higher than those[(6.1±1.1)min,(99.1±6.3)min,and 66.7%(12/18)]in the control group(t=5.311,P=0.000;t=3.284,P=0.002;Fisher’s exact test,P=0.044).There were no statistical significances in blood loss,postoperative infection,drainage tube removal time and hospitalization time between the two groups(P>0.05).ConclusionIncool-3D images can clearly show the relationship between 3D renal collecting system and complicated renal stones,enhance the compliance of patients,and improve the accuracy and safety of PCNL for complicated renal stones.