The 3d Reconstruction Of Kidney Artery's Numerical Anatomy Study In The Puncture Fixing Of MPCNL

Objective:By the 3D reconstruction of kidney artery and the pelvis to approach the best location of puncture in the minimally invasive percutaneous nephrolithotomy (mPCNL), in order to guide the clinic doctor to select the fixing of puncture,and to prevent severe hemorrhage.Method :12 cases of adulthood fresh kidney specimens,male 8 cases and female 4 cases.1. Fresh kidney specimens general anatomied,choose the center incision of abdominal. from the xiphoid process to the symphysis pubis, cascade slit the skin,superficial fascia and muscle,reveal the parietal peritoneum. slit the peritoneum,and turns the abdominal cavity contents to the opposite side, incision the back of peritoneum. exposed the kidney week fascia, passive dissociation the kidney and the connective tissue (to be far away from kidney essence as far as possible), define the renal artery, approaches the abdomen aorta and the vena cava inferior,cut-off kidney peduncle as far as possible.drifts away and shuts off the ureter,takes out the fresh kidney. intubation the renal artery and the ureter, giving the physiological saline flushes several times repeatedly, prepares to infusion.2. use the 20ml injector infusion the fresh renal artery with CMC/LO, by the even pressure. until can feel the obvious resistance,and the kidney essence surface presents red-orange punctual.after that,we infusion the same irrigation material into the renal pelvis from the end of the ureter, until the drag increment up.3. Carries on the CT scanning using 16 row of multi-layered screws, uses the Mimics software to reconstruct the three dimensional images of the renal artery and the renal pelvis. 4. Use the three dimensional reconstruction images to surveys the data. The results carries on statistics analysis by SPSS16.0.Result:1. Using the irrigation material CMC/LO infuse the renal artery ,and scanning by 16 row of multi-layered screws CT. after that ,use the mimics to reconstruct the three dimensional images can clearly, continuously demonstrate the renal artery 4-6 levels of branches. We can distinguish the renal artery clearly from the three dimen- sional image each branch and the distribution ranges.2. Carries on the renal pelvis infusion and scanning, also use the Mimics to reconstruct it can clearly, demonstrate the renal pelvis as well as the upper, middle and lower calyxs and kidney small full.3. Union the three dimensional reconstruction images of kidney section artery and the renal pelvis. in order to clear about the existence of the kidney surface deficiency area vasculosa. to provide the basis for mPCNL technique.4. By the survey to 12 cases of fresh kidney specimens'three dimensional reconstruction data, to obtain the kidney cerebral cortex to be away from each puncture depth for 23.75±0.22mm.5. We also can obtains the kidney each puncture angle as well as the angle range of variation demonstrates in the puncture kidney.the range of upper calyxs group: 67.85±0.20°～70.64±0.15°,57.20±0.06°～60.27±0.10°; the range of middle calyxs group:49.10±0.14°～70.24±0.08°, 75.25±0.12°～92.84±0.11°;the range of lower calyxs group: 62.60±0.12°～67.37±0.13°,107.34±0.14°～114.47±0.18°. From these results,we find that the range of middle calyxs group is bigger than the upper and the lower obviously.6. After sweepen the abdomen, the three dimensional reconstruction of bone, the kidneys and the skin images which are fusion with the renal artery and the renal pelvis image reconstructs ,the kidney as well as the kidney artery's position can be demonstrated very well. It also can provides the reliable basis for the simulation puncture surgery. Conclusions:1. Use the irrigation material own the fine stability. through the CT scanning, the tiny vessel's branch can be demonstratd very good, in order to further understand the renal artery's regulations.2. By the kidney section artery as well as the renal pelvis 3-dimensional reconstruction, can be clearly explicit the renal artery in the kidney essence's distributed rule.3. Use the renal artery 3-dimensional reconstruction images to surveied and compared the best puncture channel's, we can easily find that puncture the renal pelvis's middle group of back calyx is more safer.