Clinical Application Of 3D Printing Technology Combined With PCNL In The Treatment Of Staghorn Kidney Calculus

Objective: to explore the clinical application value of 3D printing combined with percutaneous nephrolithotomy(PCNL)in the treatment of staghorn calculus.Methods: From January 2015 to December 2017,51 patients with staghorn kidney calculus admitted to the First Affiliated Hospital of Guangxi Medical University who planned to undergo percutaneous nephrolithotripsy(PCNL)were included in the study.They were randomly divided into the 3D printing(18cases)group and the control group(33 cases).Among the patients in the 3D printing group,preoperative CT plain scan and enhanced examination was completed,then we extracted the DICOM format file of CT examination.After data processing,3D printing was performed to obtain the kidney model of patients with the ratio of 1:1 which applied to the patient's preoperative communication and surgical planning.Meanwhile patients in the control group underwent preoperative communication and surgical planning according to the results of conventional imaging(CT)examination.After patients(patients or their family members)were asked to fill in the questionnaire.Eventually,the operative time,channel size,channel number,intraoperative blood loss,primarystone removal rate,the occurrence rate of multi-phase stone removal,final stone removal rate and postoperative complications were compared between the two groups.Results: All the patients in the 3D printing group successfully printed the kidney model.There was no significant difference in gender,age,surgical site(left/right),maximum diameter of stones,CT value of stones,BMI,hypertension,diabetes and preoperative creatinine between the two groups(P>0.05).The score of the questionnaire was higher in the 3D printing group than in the control group(P<0.05).There were no significant differences between the two groups in terms of operation time,number of channels,channel size,final clearance rate of stones and incidence of complications(P>0.05).The first-stage stone-clearing rate was higher,the incidence of multi-phase stone removal was lower,and the intraoperative blood loss was less than that of the control group.Comparison of patients with multiple stage and those with single stage in PCNL(P<0.05).The hospitalization days and hospitalization costs of the patients with single stage of PCNL were far less than those with multi-phase.The difference was statistically significant(P<0.05).Conclusion: 1.The application of 3D printing model in communication can improve the understanding of the communicated object on kidney stone disease,surgical methods and surgical risks,as well as improve the satisfaction of the conversation,and build a good relationship between patients and doctors.2.The individualized 3d-printed kidney model can accurately display the blood vessel trend of the kidney and the three-dimensional spatial relationship between blood vessels and calyces.The application of 3D model in preoperative planning and intraoperative reference can help surgeons avoid important blood vessels,establish a safe lithotomy channel,reduce intraoperative blood loss,reducepatient injury and reduce surgical risk.3.3D-printing model represent of the spatial distribution and stone of kidney collecting system,auxiliary performer in establishing channels and choose the best puncture angle into the road,can help the performer in the gravel process quickly and accurately locate calyx calculi in goals,so as to improve the efficiency of qing dynasty stone,indirectly reduce part antler shape with calculous and hospitalization expenses of such confinement,easing the burden on patients,have clinical application value.