3D打印技术应用于肾部分切除术术前评估中的临床意义  

Clinical implications of 3D printing technology in preoperative evaluation of partial nephrectomy

作　　者：王胤钊 陈敏丰[1] 李杨乐[1] 赵诚 童时宇[1] 蔡燚 王睿哲 周泰来 WANG Yinzhao;CHEN Minfeng;LI Yangle;ZHAO Cheng;TONG Shiyu;CAI Yi;WANG Ruizhe;ZHOU Tailai(Department of Urology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院泌尿外科,长沙410008

出　　处：《中南大学学报（医学版）》2022年第3期328-333,共6页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2017JJ3477)。

摘　　要：目的:肾癌是一种泌尿系统常见的恶性肿瘤,肾部分切除术是早期肾癌的常用手术方式。3D打印技术可将患者的影像学检查数据利用三维数字模型建立一个可视化的立体影像模型。外科医生可以通过此模型进行术前评估,明确肿瘤的位置、深度及血供情况等,有助于制订术前计划,实现更好的手术效果。本研究采用R.E.N.A.L评分系统对肾癌进行分层,探讨3D打印技术在腹腔镜下肾部分切除术中的临床应用价值。方法:选取2019年6月至2020年12月于中南大学湘雅医院接受腹腔镜下肾部分切除术的114例肾肿瘤患者。按是否完善3D打印技术进行分组,分为实验组(52例)和对照组(62例),比较2组患者围手术期指标的差异;根据R.E.N.A.L评分将肾部分切除术难度分为低度复杂组(4~6分)39例、中度复杂组(7~9分)32例、高度复杂组(10~12分)43例,比较低、中、高度复杂手术组中实验组与对照组患者围手术期指标的差异。结果:实验组的手术时间、热缺血时间、术后住院时间均短于对照组(均P<0.05),术中失血量少于对照组(P=0.047),术后血肌酐水平变化小于对照组(P=0.032)。在低度复杂组中,实验组与对照组的手术时间、热缺血时间、术中失血量、术后血肌酐水平变化、术后住院时间比较差异均无统计学意义(均P>0.05)。在中、高度复杂组中,实验组的手术时间、热缺血时间、术后住院时间均短于对照组(均P<0.05或P<0.001),术中失血量均少于对照组(分别为P=0.022和P<0.001),术后血肌酐水平变化均小于对照组(分别为P<0.05和P<0.001)。结论:与R.E.N.A.L评分<7分的肾肿瘤患者相比,3D打印技术对于R.E.N.A.L评分≥7分的肾肿瘤患者肾部分切除术前进行评估可能有更大的临床意义。Objective: Renal cancer is a common malignancy of the urinary system, and the partial nephrectomy is a common surgical modality for early renal cancer. 3D printing technology can create a visual three-dimensional model by using 3D digital models of the patient’ s imaging data. With this model, surgeons can perform preoperative assessment to clarify the location, depth, and blood supply of the tumor, which helps to develop preoperative plans and achieve better surgical outcomes. In this study, the R.E.N.A.L scoring system was used to stratify patients with renal tumors and to explore the clinical application value of 3D printing technology in laparoscopic partial nephrectomy.Methods: A total of 114 renal cancer patients who received laparoscopic partial nephrectomy in Xiangya Hospital from June 2019 to December 2020 were enrolled. The patients were assigned into an experimental group(n=52) and a control group(n=62)according to whether 3D printing technology was performed, and the differences in perioperative parameters between the 2 groups were compared. Thirty-nine patients were assigned into a low-complexity group(4-6 points), 32 into a moderate-complexity group(7-9 points), and 43 into a high-complexity group(10-12 points) according to R.E.N.A.L score, and the differences in perioperative parameters between the experimental group and the control group in each score group were compared.Results: The experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay(all P<0.05), less intraoperative blood loss(P=0.047), and smaller postoperative blood creatinine change(P=0.032) compared with the control group.In the low-complexity group, there were no statistically significant differences between the experimental group and the control group in operation time, renal ischemia time,intraoperative blood loss, postoperative blood creatinine changes, and postoperative hospital stay(all P>0.05). In the moderate-and high-complexity groups, the experimental group had shorter operative time

关 键 词：肾肿瘤 肾部分切除术 3D打印技术 R.E.N.A.L评分 

分 类 号：R737.11[医药卫生—肿瘤]