| Objective The purpose of this study was to study the tumor blood supply,anatomical location and adjacent structure of patients with kidney cancer by using 3D printing in combination with R.E.N.A.L.The score effectively guides the preoperative evaluation and intraoperative guidance to achieve a trifecta of negative surgical margins,minimal renal decline,and no urinary complications;And further explore the application value of 3D printing technology in preoperative and intraoperative planning and implementation of laparoscopic partial nephrectomy under different R.E.N.A.L.scores.Methods Collect the data of patients diagnosed with renal cancer and undergoing partial nephrectomy in the General Hospital of Ningxia Medical University from January2020 to December 2022.Preoperative general capital data were collected,including age,sex,neutrophil relative value,platelet,blood glucose,kidney GFR,maximum tumor diameter,tumor stage,and R.E.N.A.L.Score,MAP score,operation time,heat ischemia time,intraoperative bleeding,postoperative drainage volume,postoperative hospital stay,and creatinine change amplitude 3 months after surgery.According to the inclusion and exclusion criteria,a total of 126 patients were enrolled,including 25 patients who received laparoscopic partial nephrectomy with 3D printing kidney model,86 patients who received conventional laparoscopic nephrectomy,and 15 patients who received robotic partial nephrectomy with 3D printing kidney model.Compared the 3D printing assisted laparoscopic group and the ordinary laparoscopic group,4 to 6 points R.E.N.A.L.Score the 3D printing assisted laparoscopic group and the ordinary laparoscopic group,7 points or above R.E.N.A.L.Perioperative relevant data and follow-up results of the 3D print-assisted laparoscopy group and the general laparoscopy group,as well as the 3D print-assisted laparoscopy group and the3 D print-assisted robotic laparoscopy group were scored.SPSS26.0 statistical software was used to analyze the data of the two groups.P<0.05,indicated differences and statistical significance.Results 1.There were statistically significant differences between the 3D printing group and the ordinary laparoscopic group in warm ischemia time(21.03 ± 4.64 min vs 24.63± 5.20 min,P<0.05),intraoperative bleeding volume(74.00 ± 25.19 ml vs 99.19 ± 51.75 ml,P<0.05),postoperative drainage volume(102.00 ± 91.45 ml vs 162.40 ± 162.67 ml,P<0.05)and postoperative hospitalization time(4.70 ± 1.08 d vs 5.61 ± 2.16 d,P<0.05).The general data of the two groups of patients were analyzed in terms of age,sex,relative value of neutrophils,platelets,blood glucose,tumor location,GFR of the affected kidney,maximum diameter of tumor,tumor TNM stage,In the R.E.N.A.L.score,R expressed by the maximum diameter of the tumor,E expressed by the bulge rate of the tumor,N expressed by the tumor distance collection system,and A expressed by the tumor located at the ventral/dorsal side of the kidney,MAP score,and there was no statistically significant difference(P>0.05).In the general data,the R.E.N.A.L.score(6.80 ± 1.98 vs 5.88 ± 1.62)and L tumor were located at the upper/lower levels of the kidney(2.17 ± 0.90 vs 1.66 ± 0.78,P<0.05),the difference was statistically significant(P<0.05).It shows that the R.E.N.A.L.score of renal tumors in the 3D printing group is higher than that in the ordinary laparoscopic group,and the L tumor is located above/below the kidney,and the tumor is more complex.L tumor located at the upper/lower level of the kidney is a key factor affecting the complexity of the tumor.3D printing technology has greatly optimized this item,enabling more complex tumors to obtain better perioperative and postoperative indicators after surgery.2.3D print-assisted laparoscopy group and ordinary laparoscopy group had statistically significant differences in warm ischemia time(22.16 ± 4.90 min vs 24.63 ± 5.20 min,P<0.05),intraoperative bleeding volume(80.80 ± 23.62 ml vs 99.19 ± 51.75 ml,P<0.05),postoperative drainage volume(93.00 ± 110.01 ml vs 162.40 ± 162.67 ml,P<0.05)and postoperative hospital stay(4.43 ± 1.22 d vs 5.61 ± 2.16 d,P<0.05).There was no statistically significant difference between the two groups in the general data of age,sex,relative value of neutrophils,platelets,blood glucose,tumor location,GFR of the affected kidney,maximum diameter of tumor,tumor TNM stage,R.E.N.A.L.score,In the R.E.N.A.L.score,R refers to the maximum diameter of the tumor,E refers to the protruding rate of the tumor,N refers to the tumor distance collection system,and A refers to the tumor located at the ventral/dorsal side of the kidney,MAP score(P>0.05).In general data,L tumors were located at the upper/lower levels of the kidney(2.12 ± 0.92 vs 2.12 ± 0.92,P<0.05),and the difference was statistically significant(P<0.05).The 3D print-assisted laparoscopy group is more complex than the ordinary laparoscopy group in terms of L tumor located above/below the kidney.The use of3 D printing technology has greatly optimized this item,enabling more complex tumors to obtain better perioperative and postoperative indicators after surgery.3.4-6 points R.E.N.A.L.score 3D printing assisted laparoscopy group and common laparoscopy group had significant differences in intraoperative bleeding volume(73.08 ±19.32 ml vs 107.41 ± 51.08 ml,P<0.05).There was no statistically significant difference between the two groups in the general data of age,sex,relative value of neutrophils,platelets,blood glucose,tumor location,GFR of the affected kidney,tumor maximum diameter,tumor TNM stage,R.E.N.A.L.score,In the R.E.N.A.L.score,R tumor maximum diameter,E tumor protrusion rate,N tumor distance collection system,A tumor located at the ventral/dorsal side of the kidney,L tumor located at the upper/lower part of the kidney,and MAP score(P>0.05).3D printing technology does not show obvious advantages for renal tumors with 4-6R.E.N.A.L.scores(i.e.,low-grade complex renal tumors).4.There were statistically significant differences in the operation time(134.08 ± 42.00 min vs 158.46 ± 31.33 min,P<0.05),warm ischemia time(22.92 ± 5.09 vs 27.71 ± 5.17,P<0.05),postoperative drainage fluid volume(72.92 ± 72.72 ml vs 193.61 ± 179.78 ml,P<0.05)and postoperative hospital stay(4.42 ± 0.98 d vs 5.98 ± 1.21 d,P<0.05)between the3 D print-assisted laparoscopy group and the ordinary laparoscopy group with R.E.N.A.L.scores of 7 and above(P<0.05).There was no statistically significant difference between the two groups in general data,such as age,sex,relative value of neutrophils,platelet,blood glucose,tumor location,GFR of affected kidney,maximum diameter of tumor,tumor TNM stage,In the R.E.N.A.L.score,R represents the maximum diameter of the tumor,E represents the tumor convexity,N represents the tumor distance collection system,and A represents the tumor located at the ventral/dorsal side of the kidney,and MAP score(P>0.05).In the general data,the R.E.N.A.L.score(8.50 ± 0.91 vs 7.79 ± 1.00,P<0.05)and L tumor were located at the upper/lower levels of the kidney(2.12 ± 0.92 vs 2.12 ± 0.92,P<0.05),the difference was statistically significant(P<0.05).It shows that the R.E.N.A.L.score of renal tumors with 7points or more in the 3D printing assisted laparoscopy group is higher than that in the ordinary laparoscopy group in the R.E.N.A.L.score and the L tumor is located at the upper/lower level of the kidney,and the tumor is more complex.L tumor located at the upper/lower level of the kidney is a key factor affecting the complexity of the tumor.3D printing technology has greatly optimized this item,enabling more complex tumors to obtain better perioperative and postoperative indicators after surgery.5.There were statistically significant differences between the 3D print-assisted laparoscopy group and the 3D print-assisted robot laparoscopy group in warm ischemia time(22.16 ± 4.90 min vs 19.13 ± 3.58 min,P<0.05),intraoperative blood loss(80.80 ± 23.62 ml vs 62.67 ± 24.34 ml,P<0.05),and postoperative hospital stay(4.43 ± 1.22 vs 5.15 ± 0.60,P<0.05)(P<0.05).There was no statistically significant difference between the two groups in the general data of age,sex,relative value of neutrophils,platelets,blood glucose,tumor location,GFR of the affected kidney,tumor maximum diameter,tumor TNM stage,R.E.N.A.L.score,In the R.E.N.A.L.score,R is the maximum diameter of the tumor,E is the tumor protrusion rate,N is the tumor distance collection system,A is the tumor located at the ventral/dorsal side of the kidney,L is the tumor located at the upper/lower level of the kidney,and MAP score(P>0.05).Compared with the 3D print-assisted laparoscopy group,the 3D print-assisted robot laparoscopy group has better indicators of warm ischemia time and intraoperative bleeding,which reflects the advantages of the robot.For the postoperative hospital stay,the 3D print-assisted robot laparoscopy group has a longer time than the 3D print-assisted laparoscopy group,which may be caused by the treatment group of our department observing the robot surgery for 1-2 days.6.Postoperative pathology: 91 cases of renal clear cell carcinoma,21 cases of chromophobe cell carcinoma,8 cases of eosinophilic tumor,2 cases of multilocular cystic renal tumor with low malignant potential,2 cases of granular cell carcinoma,1 case of mixed(clear cell+granular cell)renal carcinoma,and 1 case of collecting duct carcinoma.The tumor margins were negative.Conclusion 1.3D printing technology shows different application values in partial nephrectomy with different degrees of complexity.For patients with R.E.N.A.L score ≥ 7,preoperative 3D printing evaluation may be more beneficial.2.In this study,the L tumor in the R.E.N.A.L.score is located at the upper/lower level of the kidney,which is the key factor affecting the complexity of the tumor.The use of 3D printing technology has greatly optimized this item,allowing more complex tumors to obtain better perioperative and postoperative indicators after surgery.3.3D printing technology combined with robots can further improve the advantages and expand the convenience of surgery. |
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