| BackgroundLaparoscopic partial nephrectomy is the standard surgical procedure for the T1 stage of renal tumor because it can achieve the same effect as radical nephrectomy while retaining part of the renal function.Because the laparoscopic partial nephrectomy involves complex operation such as temporary renal artery occlusion,tumor resection and defect repair,the lack of precise preoperative planning can lead to severe renal ischemic injury and surgical complications.Traditional CT is difficult to meet the precise planning requirements of the operators.Recently,renal 3D reconstruction techniques can clearly show the spatial adjacent relationship between renal vessels,tumors and collection systems,and provide help for individualized surgery.However,the current 3D reconstruction techniques have low efficiency,poor accuracy,and lack of systematic clinical application.The 3D technique has the advantage of laparoscopic kidney surgery.The value of its application has not been fully reflected.The purpose of this study is to improve the accuracy and efficiency of renal 3D reconstruction,and to further explore the advantages of 3D technology through clinical comparative study.ObjectiveTo study the method of high-precision renal CT scan based on 3D reconstruction technology,and to establish the specialized urological 3D reconstruction technology platform based on the clinical need.By analyzing and measuring the anatomical parameters of the kidney 3D model,we explored the value of the space measurement under the 3D technology platform for laparoscopic partial nephrectomy,and initially established the 3D technology application method in renal tumors.MethodsBuild urological 3D technology systemAccording to the requirement of three-dimensional reconstruction,we improved the CT image of the kidney.The improvement focuses on the image layer thickness,resolution and the usage of contrast medium and the phases of scanning.A total of 102 high-quality renal CT data from December 2015 to December 2017 were collected.The data were mainly based on renal tumors and renal calculus.Then we developed the "Uromedix-3D"System(Patent No.:2017SR200785),which is a three-dimensional reconstructive and 3D printing technology platform of urology,and reconstructed 102 cases kidney data.The 3D model of space measurement technology used in preoperative communication between surgical planning and clinical teaching.Applications of 3D technology in LPNApril 2016 to December 2017,we collected 88 cases clinical data of laparoscopic partial nephrectomy in our hospital.Among them,42 cases(3D group)underwent LPN based on 3D reconstruction or 3D printing technique of Uromedix-3D System.The remaining 46 cases of renal tumor patients(CT group)underwent the same surgery only using CT images for surgical planning.Statistical analysis of the general information,intraoperative data(operation time,warm ischemia time,tumor resection time,suture defects time,the number of collection system repair,intraoperative blood loss,blood transfusion cases),postoperative data(Postoperative abdominal drainage,glomerular filtration rate reduction,postoperative hospital stay,postoperative pathology,the number of positive margins)and complications(blood vessels injuries,postoperative bleeding and urinary fistula).ResultsThree-dimensional reconstruction resultsThe renal reconstruction process required no additional manual treatment and took an average of 31.4±13.1 minutes.The reconstructions of renal tumor were complete,clear and.smooth.3D measurement of the tumor and the collection system was 3.2 ± 2.4cm,the length of the renal defect 2.9 ± 1.1cm,width 2.7 ± 0.9cm,depth 2.2 ± 0.8cm.Two cases of accessory renal artery and two cases of early branching of renal artery were found during 3D reconstructionSurgical results between 3D group and CT groupThe gender,age,body mass index,tumor diameter,tumor location,R.E.N.A.L score and preoperative estimated glomerular filtration rate(eGFR)were not considered statistically significant;The results of perioperation in group 3D and group CT were as follows:the operation time(122.1±44.6 vs.148.0±67.4 min,P=0.011),the warm ischemia time(24.2 ± 4.2 vs.26.5±5.4 min,P = 0.030),the renal tumor resection time(7.8±2.4 vs.9.0±2.7min,P=0.032),the renal defect suture time(16.3±3.0 vs.17.5±3.5min,P=0.085),the retroperitoneal drainage volume of 24h(81.9±30.9 vs.97.8±27.6 ml,P=0.012),the retroperitoneal drainage of 48 hours(120.1±45.8 vs.140.4±39.6 ml,P=0.028),the repair of collecting system(15/27 vs.20/26,P = 0.406),the bleeding volume(59.8±44.9 vs.64.7±48.1 ml,P = 0.625),the reduction of eGFR(20.5±14.7 vs.24.3±17.3,P = 0.266),postoperative hospitalization(6 vs.7,P = 0.084).Complications of 3D group and CT group:CT group showed two cases of renal vein injury,and blood transfusion were performed during the operations.No vascular injury or blood transfusion was found in the 3D group.One patient in CT group underwent selective arterial embolization due to retroperitoneal hemorrhage at 7 days after operation.There were 3 cases of CT group and 2 cases of 3D group had transient hematuria.There was no urinary fistula in both groups.Conclusions1.High precision renal enhanced CT scan is the basis for 3D reconstruction of kidney.High precision CT image can not only improve the accuracy of reconstruction,but also simplify the process of three-dimensional reconstruction.2.The three-dimensional reconstruction technology platform(Uromedix-3D system)can complete the three-dimensional reconstruction of kidney and other structures more accurately and efficiently.The spatial measurement based on 3D model is more convenient and accurate than the traditional CT's plane measurement.3.In the surgical planning of laparoscopic partial nephrectomy,the three-dimensional model is more intuitive and visualized in vascular localization,tumor resection and defect repair than two-dimensional images,effectively reducing renal warm ischemia time and postoperative complications. |
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