Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510282, People's Republic of China.
World J Urol. 2013 Dec;31(6):1587-92. doi: 10.1007/s00345-012-0998-7. Epub 2012 Dec 8.
To construct a three-dimensional (3D) model of renal stones to facilitate comprehensive planning for percutaneous nephrolithotomy (PCNL) and to assist in surgery.
Fifteen patients with complex renal stones, including one patient with a horseshoe kidney, eight patients with partial/complete staghorn, and six patients with multiple renal stones, participated in our study. Computed tomography images of the unenhanced, arterial, venous, and excretory phases were obtained before surgery. Image segmentation and 3D reconstruction of the renal stones were performed using Mimics 12.1 software. A virtual safe and reliable percutaneous renal access route were established for each patient by comprehensive planning based on the 3D model of renal stones. PCNL was subsequently performed with the assistance of the 3D model. Patient demographics, surgical details, and postoperative treatment parameters were recorded.
The 3D models of renal stones accurately represented the interrelationships between the intrarenal arteries and veins, collecting system, stones, and adjacent anatomical structures. PCNL was completed successfully in all 15 patients. The mean operating time was 75.6 ± 13.4 min. The change in hemoglobin concentration was 1.2 ± 0.3 g/l. The one-stage stone-free rate was 93.3%, and the final stone-free rate was 100%. No major postoperative complications were noted, except for postoperative pain in one case.
Construction of a 3D model of renal stones with the aim of minimizing the risks of percutaneous procedures and achieving higher one-stage stone-free rates is feasible for comprehensive PCNL planning and assistance in patients with complex renal stones.
构建肾结石的三维（3D）模型，以利于经皮肾镜碎石术（PCNL）的全面规划，并辅助手术。
本研究纳入了 15 例复杂肾结石患者，包括 1 例马蹄肾患者、8 例部分/完全鹿角形结石患者和 6 例多发性肾结石患者。术前获取了未增强、动脉期、静脉期和排泄期的 CT 图像。使用 Mimics 12.1 软件对肾结石进行图像分割和 3D 重建。根据肾结石的 3D 模型，对每位患者进行全面规划，建立虚拟的安全可靠的经皮肾入路。随后在 3D 模型的辅助下进行 PCNL。记录患者的人口统计学、手术细节和术后治疗参数。
肾结石的 3D 模型准确地反映了肾内动脉和静脉、收集系统、结石和邻近解剖结构之间的相互关系。15 例患者均成功完成 PCNL。平均手术时间为 75.6±13.4 分钟。血红蛋白浓度变化为 1.2±0.3g/l。一期结石清除率为 93.3%，最终结石清除率为 100%。除 1 例患者术后疼痛外，无重大术后并发症。
为了降低经皮手术的风险并实现更高的一期结石清除率，构建肾结石 3D 模型用于全面的 PCNL 规划和辅助复杂肾结石患者是可行的。
