术前三维数字重建规划技术在输尿管软镜钬激光碎石术治疗肾盏结石中的应用  

Application of preoperative planning based on three-dimensional medical image reconstruction for flexible ureteroscopic holmium laser lithotripsy in treatment of caliceal lithiasis

作　　者：陈维刚[1] 赵伟[1] 赵兴旭 双卫兵[2] 原小斌[2] CHEN Weigang;ZHAO Wei;ZHAO Xingxu;SHUANG Weibing;YUAN Xiaobin(Department of Urology,the Sixth Division Hospital of Xinjiang Production and Construction Corps,Wujiaqu,Xinjiang Production and Construction Corps 831300,China;Department of Urology,First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]新疆生产建设兵团第六师医院泌尿外科,新疆生产建设兵团五家渠市831300 [2]山西医科大学第一医院泌尿外科,山西太原030001

出　　处：《中国医学工程》2022年第4期6-10,共5页China Medical Engineering

基　　金：新疆兵团第六师五家渠市科技计划项目(2138);山西省回国留学人员科研资助项目(HGKY2019097);山西医科大学第一医院博士基金(YB161710)。

摘　　要：目的探讨评估术前三维数字重建规划技术在输尿管软镜钬激光碎石术治疗肾盏结石中的应用价值。方法回顾性分析2018年6月至2021年6月间在新疆生产建设兵团第六师医院手术治疗肾盏结石的49例患者的临床资料。从2021年1月之前采用纤维输尿管软镜钬激光碎石取石术的29例患者中选取出21例作为对照组(B组);2021年1月之后针对拟接受输尿管软镜钬激光碎石取石术的20例患者作为研究组(A组),并常规在术前运用个体化三维医学影像重建与导引系统(3D-MIRGS)进行手术设计及规划。比较两组患者在手术时间、寻及结石时间、术中出血量、术后住院天数、结石清除率(术后4周评估)、围手术期并发症发生情况(改良的Clavien-Dindo分级系统)、术后一周体力恢复状况(Karnofsky体力评分)等指标。结果与B组患者相比,A组患者平均手术时间(43.3 min vs.58.2 min,P<0.05)、平均寻及结石时间(3.4 min vs.6.6 min,P<0.05)、平均术后住院天数(3.2 d vs.5.5 d,P<0.05)、围手术期并发症发生率(10.0%vs.14.3%,P<0.05)均显著下降,术后一周体力恢复状况(89.8分vs.82.5分,P<0.05)则显著提高。术中出血量及结石清除率在两组患者间均无显著差异(P>0.05)。结论三维数字重建规划技术可帮助术者在输尿管软镜联合钬激光治疗肾盏结石前,完成对腔内结石的空间精准定位工作,并先期制定个性化的具体手术策略,使术中寻石过程更为顺畅,手术效率得以有效提升,有利于患者术后快速恢复。【Objective】To investigate and evaluate the feasibility and effectiveness of preoperative planning based on threedimensional medical image reconstruction for flexible ureteroscopic holmium laser lithotripsy in the treatment of caliceal lithiasis.【Methods】The data of 49 patients diagnosed as caliceal lithiasis and were performed the flexible ureteroscopic holmium laser lithotripsy by a single surgeon(Chen Weigang)between June 2018 and June 2021 were retrospectively reviewed.According to the principle of case-control study,21 cases were selected out of 29 cases who underwent traditional flexible ureteroscopic holmium laser lithotripsy before January 2021 and served as control group(group B),and 20 cases who underwent flexible ureteroscopic holmium laser lithotripsy combined with preoperative planning based on three-dimensional medical image reconstruction were divided into observation group(group A).Operating time,stone-tracking time,postoperative hospitalization,estimated blood loss,stone-free rate,incidence of perioperative complications(Clavien-Dindo Grade),and Karnofsky score were compared between the groups.【Results】All the operations were technically successful,without reoperations or conversion to open procedures.Operating time(43.3 min vs.58.2 min,P<0.05),stone-tracking time(3.4 min vs.6.6 min,P<0.05),postoperative hospitalization(3.2 d vs.5.5 d,P<0.05)and the incidence of perioperative complications(10.0%vs.14.3%,P<0.05)were shorter/lower in group A compared with controls.Group A showed significant improvement better than group B in Karnofsky score(89.8 vs.82.5,P<0.05).No statistically significant differences in stone-free rate and estimated blood loss were found between the two groups.【Conclusion】Preoperative planning based on three-dimensional medical image reconstruction can facilitate flexible ureteroscopic holmium laser lithotripsy in the treatment of caliceal lithiasis that is both effective and safe.

关 键 词：三维数字重建 术前规划 输尿管软镜 钬激光 肾盏结石 

分 类 号：R692.4[医药卫生—泌尿科学]