Guliev B G, Komyakov B K, Talyshinskiy A E, Stetsik E O
Department of urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.
Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia.
Urologiia. 2019 Dec 31(6):21-25.
to determine the efficiency of using a non-biological dismountable 3D-model of the collecting system with color segmentation for better understanding of its anatomy by residents and to determine the optimal tactics of percutaneous nephrolithotomy (PNL).
3D-models of the collecting system were developed based on CT data of 5 patients with staghorn stones, for whom PNL was planned. CT images were obtained in the Dicom format. RadiAnt DICOM Viewer was used for delineation and segmentation of the collecting system with 3D visualization. Using slicer 4.8.1 software, virtual models were processed to convert DICOM files to STL format. Then, virtual color extraction of each group of calyxes was performed for convenient disassembling and intraluminal study of the anatomy of the collecting system. The final stage included the printing of each area by the method of layer-by-layer deposition using a 3D printer Picaso designer X. To assess the efficiency of the dismountable 3D-model that simulates a certain collecting system, a questionnaire was used. It allowed to evaluate the understanding of the anatomy of the collecting system by residents, as well as the ability to determine the optimal calyx for PNL by comparing the answers with the result of a survey of practicing urologists who had performed more than 50 cases.
After studying 3D-models by residents, determination of the number of calyxes in each group was not statistically significantly different from those for practicing urologists who used CT images. The choice of the calyx for primary puncture was not different between groups. However, residents chose the calyx for additional access worse (p=0.009).
The dismountable 3D-model of the collecting system is promising for training of residents and planning PNL. Studying the anatomy of a single group of calyxes as well as the entire collecting system allows to choose the optimal calyx for percutaneous puncture during PNL.
确定使用带有颜色分割的可拆解式肾脏集合系统非生物三维模型，以便住院医师更好地理解其解剖结构，并确定经皮肾镜取石术（PNL）的最佳策略。
基于5例计划行PNL的鹿角形结石患者的CT数据，构建肾脏集合系统的三维模型。CT图像以Dicom格式获取。使用RadiAnt DICOM Viewer进行肾脏集合系统的勾勒和分割，并进行三维可视化。利用Slicer 4.8.1软件对虚拟模型进行处理，将Dicom文件转换为STL格式。然后，对每组肾盏进行虚拟颜色提取，以便于拆解和对肾脏集合系统的腔内解剖结构进行研究。最后阶段包括使用三维打印机Picaso designer X通过逐层沉积法打印每个区域。为评估模拟特定肾脏集合系统的可拆解式三维模型的效果，采用了一份问卷。该问卷能够评估住院医师对肾脏集合系统解剖结构的理解，以及通过将答案与对已完成50多例手术的泌尿外科执业医师的调查结果进行比较，来确定PNL最佳肾盏的能力。
住院医师研究三维模型后，每组肾盏数量的确定与使用CT图像的泌尿外科执业医师相比，差异无统计学意义。两组在选择初次穿刺的肾盏方面没有差异。然而，住院医师在选择额外穿刺肾盏方面表现较差（p = 0.009）。
肾脏集合系统的可拆解式三维模型在住院医师培训和PNL手术规划方面具有前景。研究单组肾盏以及整个肾脏集合系统的解剖结构，有助于在PNL过程中选择经皮穿刺的最佳肾盏。
