3D打印技术在经皮肾镜碎石术治疗复杂性肾结石中的应用:前瞻性随机对照研究  

Clinical Application of 3D Printing Technology in Percutaneous Nephrolithotripsy for Complex Renal Calculi:a Prospective Randomized Controlled Study

作　　者：吴清国[1] 覃斌[1] 梁毅文[1] 罗翔 冯家乐 杨鹏 梁阳冰[1] 季汉初[1] 黄寿付[1] Wu Qingguo;Qin Bin;Liang Yiwen(Department of Urology,Guigang People’s Hospital,Guangxi Zhuang Autonomous Region,Guigang 537100,China)

机构地区：[1]广西壮族自治区贵港市人民医院泌尿外科,贵港537100 [2]广西数字医学与3D打印临床医学研究中心,贵港537100

出　　处：《中国微创外科杂志》2023年第6期430-435,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：贵港市科技转化成果与应用(1803004)

摘　　要：目的探讨3D打印技术在经皮肾镜碎石术(percutaneous nephrolithotripsy,PCNL)治疗复杂性肾结石中的应用价值。方法选取我院2018年12月~2021年12月120例复杂性肾结石行PCNL,按入院时间顺序编号,根据随机数字表分为3D打印组60例和对照组60例。术前均常规采用64排多层螺旋CT进行检查,比较2组建立目标肾盏通道时间、多通道情况、手术时间、结石清除率、血红蛋白下降值、并发症发生率、肾造瘘管留置时间、住院时间等。结果3D打印组60例成功打印出包括肾段脊柱、第11及12肋骨、肾脏、结石、肾动脉的1∶13D模型。2组患者均成功行PCNL。3D打印组建立目标肾盏时间明显短于对照组[(9.1±1.1)min vs.(10.1±1.2)min,t=-4.751,P=0.000]。3D打印组与对照组手术时间、拔除肾造瘘管时间差异均无显著性[(128.3±57.1)min vs.(142.8±45.3)min,t=-1.535,P=0.127;(5.8±1.4)d vs.(6.5±2.1)d,t=-1.965,P=0.052]。3D打印组多通道率80.0%(48/60)与对照组86.7%(52/60)差异无显著性(χ^(2)=0.960,P=0.327)。3D打印组一期结石清除率83.3%(50/60),明显高于对照组60.0%(36/60)(χ^(2)=8.044,P=0.005)。3D打印组血红蛋白下降值中位数3.0(-10.0~16)g/L明显少于对照组5.5(-2.0~21.0)g/L(Z=-2.695,P=0.007)。3D打印组并发症发生率35.0%(21/60),与对照组45.0%(27/60)差异无显著性(χ^(2)=1.250,P=0.264)。2组住院时间有显著差异[(7.0±1.3)d vs.(8.3±2.4)min,t=-3.775,P=0.000]。结论3D打印肾脏模型可以准确显示肾盏结构及结石分布,有利于PCNL术前穿刺规划、精准穿刺建立穿刺通道,减少术中出血,提高结石清除率。Objective To explore the application value of 3D printing technology in percutaneous nephrolithotripsy(PCNL)for complex renal calculi.Methods Clinical data of 120 patients with complex renal calculi who underwent PCNL in our hospital from December 2018 to December 2021 were reviewed.According to the chronological order of their admission,the 120 patients were randomly divided into two groups based on a random number table:60 patients for 3D printing group and 60 patients for conventional image group.The 64 slice multi-slice spiral CT was routinely used in both groups before operation.The time for establishing the target renal calyceal channel,proportion of multi-channel,operation time,stone clearance rate,decreased value of hemoglobin,incidence of complications,retention time of nephrostomy tube,and length of hospital stay were compared between the two groups.Results The 3D printing group successfully printed 1∶13D models of the renal spine,11th and 12th ribs,kidneys,stones,and renal artery in the 60 cases.The PCNL was successfully performed in both groups.The time of establishing target renal calices in the 3D printing group was significantly shorter than that in the control group[(9.1±1.1)min vs.(10.1±1.2)min,t=-4.751,P=0.000].There were no significant differences between the 3D printing group and the control group in the operation time and removal time of renal fistula[(128.3±57.1)min vs.(142.8±45.3)min,t=-1.535,P=0.127;(5.8±1.4)d vs.(6.5±2.1)d,t=-1.965,P=0.052].There was no significant difference in multi-channel rate between the 3D printing group and the control group[80.0%(48/60)vs.86.7%(52/60),χ^(2)=0.960,P=0.327].The primary stone clearance rate of the 3D printing group was significantly higher than that of the control group[83.3%(50/60)vs.60.0%(36/60),χ^(2)=8.044,P=0.005].The decrease of hemoglobin in the 3D printing group was significantly less than that in the control group[3.0(-10.0-16)g/L vs.5.5(-2.0-21.0)g/L,Z=-2.695,P=0.007].There was no significant difference in complication rate between

关 键 词：3D打印技术 复杂性肾结石 经皮肾镜碎石术 

分 类 号：R699.2[医药卫生—泌尿科学]