基于CT三维重建成像术前3D打印模型模拟手术操作在经皮肾镜碎石取石术中的应用

doi:10.7517/issn.1674-0475.221026

摘要/Abstract

摘要： 本研究探讨基于CT三维重建成像术前3D打印模型模拟手术操作在经皮肾镜碎石取石术治疗复杂性肾结石患者的效果。选取96例复杂性肾结石患者，采取随机分组方式分为3D组、常规组，各48例，3D组采用基于CT三维重建成像术前3D打印模型模拟经皮肾镜碎石取石手术操作方式实施治疗，常规组仅采取手术前CT三维重建进行手术定位下经皮肾镜碎石取石术治疗。对比两组患者手术时间、手术出血量、单次穿刺成功率、术后结石清除率，以及外周血白细胞计数（WBC）、血红蛋白（Hb），血清降钙素原（PCT）、C反应蛋白（CRP）、胱抑素C （CysC）、血尿素氮（BUN）、血肌酐（Scr）的变化，并记录两组患者的手术并发症发生情况。3D组的手术时间、手术出血量均低于常规组患者，3D组患者的单次穿刺成功率高于常规组（P<0.05）；3D组患者在术后24 h的血清CysC水平低于常规组（P<0.05）；术前、术后24 h、术后72 h监测两组患者的外周血WBC、Hb，血清PCT、CRP变化情况，3D组和常规组患者的外周血WBC、Hb，血清PCT、CRP变化变化趋势比较，差异无统计学意义（P>0.05）；术后统计两组患者手术并发症，3D组的并发症率（4.17%）低于常规组患者的（16.67%）（P<0.05）。基于CT三维重建成像术前3D打印模型模拟手术可有效缩短手术操作时间、减少出血量，提高单次成功率，降低手术对患者肾功能的损伤程度。

关键词: CT三维重建, 3D打印, 经皮肾镜碎石取石术, 复杂性肾结石

Abstract: This study investigated the effect of preoperative 3D printing model based on CT 3D reconstruction imaging to simulate surgical operation in the treatment o f patients with complex kidney stones by percutaneous nephrolithotomy. 96 patients with complex kidney stones were selected,and they were randomly divided into a 3D group and a routine group with 48 cases in each group. The patients in 3D group were treated with preoperative 3D printed model simulates the operation of percutaneous ephrolithotomy based on CT three-dimensional reconstruction imaging, and the routine group only takes preoperative CT three-dimensional reconstruction for percutaneous nephrolithotomy under surgical positioning. The operation time, operative blood loss, success rate of single puncture, postoperative stone clearance rate, and the changes of peripheral blood white blood cells (WBC), hemoglobin (Hb), serum procalcitonin (PCT), C-reactive protein (CRP), cystatin C (CysC), blood urea nitrogen (BUN) and serum creatinine (Scr) were compared between the two groups, and the operative complications of the two groups were recorded. The operation time and operative blood loss in the 3D group were lower than those in the conventional group, and the success rate of single puncture in the 3D group was higher than that in the conventional group (P<0.05). The level of CysC at 24 hours after operation was lower than that of the routine group (P<0.05). The changes of peripheral blood WBC, Hb, serum PCT, and CRP of the two groups of patients were monitored before surgery, 24 hours after surgery, and 72 hours after surgery. There was no significant difference in the change trends of peripheral blood WBC, Hb, serum PCT and CRP between 3D group and routine group (P>0.05). After surgery the complications were counted in the two groups, the complication rate of the 3D group was 4.17% which lower than that of the conventional group 16.67% (P<0.05). The preoperative 3D printing model simulation based on CT 3D reconstruction imaging can effectively shorten the operation time, reduce the blood loss, improve the single success rate, and reduce the degree of damage to the patient's renal function.

Key words: CT 3D reconstruction, 3D printing, percutaneous nephrolithotomy, complex kidney stones

赵书晓, 李峰, 覃智标, 毕革文, 雷华, 李起广, 郑仿, 宁鑫, 黄崛倬, 顾能钰. 基于CT三维重建成像术前3D打印模型模拟手术操作在经皮肾镜碎石取石术中的应用[J]. 影像科学与光化学, 2023, 41(1): 17-22.

ZHAO Shuxiao, LI Feng, QIN Zhibiao, BI Gewen, LEI Hua, LI Qiguang, ZHENG Fang, NING Xin, HUANG Juezhuo, GU Nengyu. Application of Preoperative 3D Printing Model Simulating Operation in Percutaneous Nephrolithotomy based on CT Three-dimensional Reconstruction Imaging[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(1): 17-22.

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