| Background and Objective:At present,there are several methods for the treatment of lower pole renal calculi,such as extracorporeal shock wave lithotripsy(ESWL),percutaneous nephrolithotripsy(PCNL),retrograde intrarenal surgery(RIRS)and so on.RIRS has advantages of flexible operation,small demage,high stone clearance rate and so on.At present,it has become the first-line treatment of lower calyceal calculi.However,due to the uniqueness and complexity of the anatomic structure of the lower calyx,there are different reports on the stone clearance rate of RIRS in the treatment of lower calyx calculi at home and abroad.It is a great significance to fully understand the anatomy of the lower calyx before operation for the prediction of the curative effect of RIRS in the treatment of lower calyceal calculi.Related studies have shown that the anatomical parameters such as angle between renal pelvis and infundibulopelvic angle(IPA),infundibular width(IW)and length of infundibular length(IL)are the key indexes affecting the therapeutic effect of lower calyceal calculi.Accurate measurement of these anatomic parameters are particularly important for the successful prediction of stone removal rate of RIRS.At present,clinicians mainly use two-dimensional imaging images such as intravenous urography(IVU)to measure the anatomic parameters of the lower calyx of the kidney,so as to predict the stone removal rate of ureteroscopy.However,according to the relevant literature,the anatomic parameters of the lower calyx of kidney are greatly affected by the posture of the patients at the time of radiography,and these indexes will also change accordingly at different phases of IVU.Some scholars began to try to use three-dimensional reconstruction to study the anatomical structure of the lower calyx of the kidney,the results show that three-dimensional reconstruction can accurately reflect the anatomical structure of the lower calyx of the kidney.3D visualization reconstruction technology is a more advanced digital reconstruction technology.the 3D visualization kidney reconstructed by 3D visualization has the advantages of accuracy,visualization,quantification and so on.it can be used to observe and measure the anatomic structure of the lower calyx of kidney in an all-round way.In this study,3D visualization reconstruction of kidney was used to analyze and measure the structure of lower calyx,and to explore the value of 3D visualization reconstruction in predicting the curative effect of ureteroscopy in the treatment of lower calyceal calculi,so as to predict the difficulty of operation and the rate of stone clearance before operation.Methods:The clinical datas of 64 patients with lower calyceal calculi treated by ureteroscopy in the Department of Urology of the second affiliated Hospital of Zhengzhou University from July 2017 to January 2019 were analyzed retrospectively.Provide support to patients in the development of accurate surgical plans.According to whether the stones were completely removed in one stage,they were divided into stone removal group(group A)and stone residue group(group B).In group A,31 males and 17 females,aged(45.46 ±14.90)years,BMI(22.92 ±3.23)kg/m2,stones were(1.66 ±0.64)cm,CT values were(836.42 ±187.45)Hu,stones located in the left kidney in 26 cases,right kidney in 22 cases;Group B(M 11,F 5,age(48.31 ±12.95)years),BMI(21.81 ±2.71)kg/m2,stone size(1.83 ±0.53)cm,CT value(888.94 ±145.25)Hu,stones located in the left kidney in 9 cases.Right kidney: a report of 7 cases.The IPA,IL and IW of all patients were measured and recorded by 3D visualization reconstruction of kidney and IVU images,and the differences between the two measurement results were compared.The clinical data of all patients were analyzed by univariate analysis,and the risk factors which were statistically significant for stone clearance rate were screened out,and then Logistic multivariate analysis was carried out.To determine the independent risk factors affecting the stone clearance rate of ureteroscopy in the treatment of lower calyceal calculi.Results:All patients successfully reconstructed 3D visual renal model,and accurately measured IPA,IW,IL and other anatomical parameters of the lower calyx.There were no significant difference in sex,age and BMI between group A and group B(P > 0.05),but there was no significant difference in stone size and CT value between group A and group B(P > 0.05).IPA and IW in group A were significantly higher than those in group B(P > 0.05).There was significant difference between the two groups(P < 0.05);B group was higher than that in group A(P < 0.05),and there was significant difference between the two groups(P < 0.05),and the anatomic parameters of the lower calyx measured by 3D visualization reconstruction of kidney were compared with those measured by IVU images,and there was significant difference between the two groups(P < 0.05).There was no significant difference in IW and IL between the two groups(P > 0.05).The IPA measured by 3D visualization reconstruction of kidney was higher than that measured by IVU,and the difference was statistically significant(P < 0.05).Multivariate Logistic regression analysis showed that IW,IL and IPA were independent risk factors for lithotripsy in the treatment of lower calyceal calculi(P < 0.05).Conclusions:1.The 3D visualization kidney reconstructed by 3D visualization technology can accurately and carefully display the anatomic structure of the lower calyx,and it measured anatomic parameters of the lower calyx are more accurate.2.IPA,IW and IL are independent risk factors affecting the clearance rate of RIRS in the treatment of lower calyceal calculi.The smaller the IPA,the narrower the IW and the longer the IL,the less ideal the therapeutic effect.3.According to 3D visualization and reconstruction of kidney,the patients with complex lower calyceal structure can be screened out,and other surgical treatment methods other than RIRS can be selected as the first choice for patients with lower calyceal calculi. |
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