Abstract
Objective To explore the clinical application value of percutaneous nephrolithotripsy (PCNL) combined with 3D printing technology in the treatment of complex staghorn kidney stones. Methods From January 2018 to February 2020, a total of 72 patients with complex staghorn kidney stones admitted to our center were divided into experimental group (3D printing group) and control group (computed tomography, CT, imaging group)) according to the random block method, and a prospective cohort study was conducted. Preoperative computed tomography urography (CTU) examination was performed on all patients in the two groups, and the original CT scan Digital Imaging and Communications in Medicine (DICOM) data of patients in the experimental group were separately extracted for three-dimensional reconstruction and 3D model printing and designed a doctor-patient communication evaluation score table. The two groups were compared in score table, puncture location time, total operation time, consistency between estimated calyx and target calyx, incidence of surgical complications, stone free rate, postoperative recovery, and other aspects. Results Both groups completed preoperative CTU examination and showed good kidney and stone morphology. In the experimental group, all 3D printed models were completed and the internal anatomical structure could be clearly displayed. Simulation puncture and relevant measurement parameters could be obtained. The experimental group was significantly better than the control group in doctor-patient communication evaluation score, puncture location time, target calyx consistency, and stone free rate (p < 0.05), and there was no statistical difference in total operation time, postoperative complications, and postoperative recovery. Conclusions Individualized 3D printing technology can fully evaluate and design percutaneous renal access and stone clearing strategies before surgery. Compared with traditional preoperative imaging evaluation, 3D printing makes PCNL more accurate and efficient in the treatment of complex staghorn shaped kidney stones, with a high stone free rate at the first stage and better doctor-patient communication satisfaction.
Highlights
PCNL characterized by small trauma and high stone-free rate has become the golden standard for the treatment of staghorn renal calculi, multiple renal calculi, or renal lower calyx calculi [1]. e risk of surgery and the stone-free rate are largely related to the selection and establishment of the percutaneous renal working tract. erefore, it has become the key of PCNL surgery to confirm the relationship between the kidney and the stones, reasonably plan the renal target calyx to be chosen before surgery, and optimize the operational process of stone removal
Preoperative. 3D printing model group showed obvious advantages in four aspects of doctor-patient communication evaluation score (Table 2). (2) Intraoperative: the 3D printing group was superior to the control group (p < 0.05) in two aspects: the puncture location time, the consistency between the preoperative planned target calyx, and the intraoperative actual target calyx. ere was no significant difference in the total operation time (p > 0.05) between the two groups
Ere were two cases in 3D printing group and two cases in control group accured postoperative fever. ey were varying degrees urinary system infection cases indicated by preoperative urine routine test and urine culture, which continuously underwent antibiotic therapy. e body temperature of two patients in 3D printing group returned to normal about 3 days after receiving antibiotic treatment, and one patient in the control group recovered after 2 days, and the other patient did not improve significantly in 2 days, but returned to normal in 3 days after changing sensitive antibiotics. ere were no blood transfusion, renal artery embolism, urinary sepsis, and peripheral organ injury in both groups
Summary
PCNL characterized by small trauma and high stone-free rate has become the golden standard for the treatment of staghorn renal calculi, multiple renal calculi, or renal lower calyx calculi [1]. e risk of surgery and the stone-free rate are largely related to the selection and establishment of the percutaneous renal working tract. erefore, it has become the key of PCNL surgery to confirm the relationship between the kidney and the stones, reasonably plan the renal target calyx to be chosen before surgery, and optimize the operational process of stone removal. Erefore, it has become the key of PCNL surgery to confirm the relationship between the kidney and the stones, reasonably plan the renal target calyx to be chosen before surgery, and optimize the operational process of stone removal. Compared with simple imageological diagnosis, the advantage of 3D printing is that doctors can print out a specific mould or organ model according to Journal of Healthcare Engineering clinical needs and the individual difference of the patients’ visceral organs, making it possible to diagnose more accurately and plan a detailed operation solution on printed physical models. From January 2018 to February 2020, we made 3D models for 36 patients with staghorn kidney stones of our medical center, doing a preliminary study of surgery planning and the application of doctor-patient communication through 3D printing technology in PCNL
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