Abstract
ObjectiveCT-Urography combined with 3D printing technology, digital design, construction of individualized PCNL puncture guides, and preliminary analyze their efficacy, safety puncture positioning for PCNL.MethodsTwenty-two patients with renal calculi were randomly selected at the affiliated Hospital of Xuzhou Medical University during 2017–2018. We randomly divided the patients into two groups: in 10 experimental groups, we used our 3D printing personalized percutaneous puncture guide access plate for PCNL, and in the control group, 12 patients with standard USG guide PCNL. The accuracy of puncture position, puncture time, and intraoperative blood loss was compared.ResultsIn the experimental group, 10 patients with 3D printing personalized percutaneous puncture guide access plate. The puncture needle was accessed through the guide plate and verified by the color Doppler. The single puncture, needle position, and depth success rate were 100.00% (10/10). The angles were consistent with the preoperative design. In the control group, 12 patients via USG guided PCNL success rate was 75.00% (9/12). The puncture time and amount of hemorrhage was (7.78 ± 0.94) min and (49.31 ± 6.43) mL, and (9.04 ± 1.09) min and (60.08 ± 12.18) mL, respectively. The above data of the two groups were statistically significant (P < 0.05).Conclusion3D printing personalized percutaneous nephrolithotomy guide plate for PCNL can improve PCNL renal puncture channel positioning accuracy, shorten puncture time, reduce intraoperative blood loss, bleeding-related complications and provide a new method for PCNL renal puncture positioning, which is worthy of further clinical exploration.
Highlights
Percutaneous nephrolithotomy (PCNL) is still the mainstream treatment for complex renal calculi
Previous studies have reported that PCNL stone clearance rate and surgical risk are closely related to the choice of the renal puncture site, and the establishment of the correct renal puncture channel is the premise to complete lithotripsy and reduce the incidence of complications such as intraoperative and postoperative massive hemorrhage, liver and pleural injury, and intestinal injury [9]
We found that the 3D percutaneous nephrolithotomy guide plate was made and applied to locate the kidney before puncture and guide the direction and angle of the puncture needle during puncture to reach the optimal renal calyx where the calculi were located, which could increase the accuracy of kidney puncture and simplify the puncture process and improve
Summary
Percutaneous nephrolithotomy (PCNL) is still the mainstream treatment for complex renal calculi. The complications such as bleeding, Infection, and residual stones during and after PCNL operation are the main burden needed more attention. Using 3D printing technology to make personalized guide plates for different surgeries has been more and more applied in orthopedics and stomatology [4, 5]. This technology is still in the preliminary exploration stage in urology. Using Computed Tomography Urography (CTU), combined with 3D printing technology and digital design, the individualized percutaneous nephrolithotomy guide plate was developed. The feasibility of its application in PCNL puncture localization was preliminarily discussed
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