基于CT图像建立小儿肾结石三维模型及仿真手术的研究
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摘要
目的基于CT扫描原始图像构建小儿肾结石三维模型,为手术方式的选择提供参考。方法选取9例肾结石患儿分别进行泌尿系CT扫描检查,所得资料以DICOM格式储存并将其导入医学影像软件Mimics,通过自动与人工描绘等功能提取所需区域进行三维重建,获得小儿肾结石三维模型,并利用机械画图软件Solidworks建立手术器械模型,对三维肾结石模型进行虚拟仿真手术操作。结果成功建立了包含骨骼、肾实质、集合系统、血管、结石及毗邻器官在内的小儿肾结石三维模型及手术器械模型,并完成虚拟手术操作。结论通过Mimics软件结合CT扫描资料建立小儿肾结石三维模型有效、可行,能直观地显示肾内结构及毗邻脏器,有助于术者进行术前规划。
Objective To provide rationales for selecting surgical procedures through establishing a three-dimensional model of renal stone on computed tomography( CT) in children. Methods Spiral CT in urinary system was performed in 9 children with renal stones. The acquired data stored in DICOM format were imported into medical imaging software Mimics. 3 D reconstruction was performed through automatic and manual mapping of required areas to obtain the three-dimensional models of renal stones in children. The surgical instrument model was established by mechanical drawing software Solidworks based upon virtual simulation. Operation was performed on three-dimensional model of renal stones. Results The three-dimensional model of renal stone in children,including bones,renal substance,collective system,blood vessels,stones and adjacent organs,was established. And surgical instrument model and virtual operation were completed successfully. Conclusion The three-dimensional modeling of pediatric renal stone combining Mimics software and spiral CT data is both feasible and effective. It can delineate the internal structure of kidney and adjacent viscera. Individualized surgical procedures may be developed with virtual surgical techniques for better preoperative planning.
Objective To provide rationales for selecting surgical procedures through establishing a three-dimensional model of renal stone on computed tomography( CT) in children. Methods Spiral CT in urinary system was performed in 9 children with renal stones. The acquired data stored in DICOM format were imported into medical imaging software Mimics. 3 D reconstruction was performed through automatic and manual mapping of required areas to obtain the three-dimensional models of renal stones in children. The surgical instrument model was established by mechanical drawing software Solidworks based upon virtual simulation. Operation was performed on three-dimensional model of renal stones. Results The three-dimensional model of renal stone in children,including bones,renal substance,collective system,blood vessels,stones and adjacent organs,was established. And surgical instrument model and virtual operation were completed successfully. Conclusion The three-dimensional modeling of pediatric renal stone combining Mimics software and spiral CT data is both feasible and effective. It can delineate the internal structure of kidney and adjacent viscera. Individualized surgical procedures may be developed with virtual surgical techniques for better preoperative planning.
引文
1胡岚亭,史新华,汪清.婴幼儿尿路结石224例临床分析[J].中华临床医师杂志(电子版),2010,4(10):2033-2036.DOI:10.3969/cma.j.issn.1674-0785.2010.10.066.Hu LT,Shi XH,Wang Q.Clinical analyses of urolithiasis in infants and neonates:a report of 224 cases[J].Chin J Clinicians(Electronic Edition),2010,4(10):2033-2036.DOI:10.3969/cma.j.issn.1674-0785.2010.10.066.
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4 Watterson JD,Soon S,Jana K.Access related complications during percutaneous nephrolithotomy:urology versus radiology at a single academic institution[J].J Urol,2006,176(1):142-145.DOI:10.1016/S0022-5347(06)00489-7.
5 Yamaguchi A,Skolarikos A,Buchholz NP,et al.Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5,537patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study[J].JEndourol,2011,25(6):933-939.DOI:10.1089/end.2010.0606.
6 Bultitude M,Smith D,Thomas K.Contemporary Management of Stone Disease:The New EAU Urolithiasis Guidelines for2015[J].Eur Urol,2016,69(3):486-484.DOI:10.1016/j.eururo.2015.08.010.
7 Multescu R,Geavlete B,Geavlete P.A new era:performance and limitations of the latest models of flexible ureteroscopes[J].Urolgy,2013,82(6):1236-1239.DOI:10.1016/j.urology.2013.07.022.
8 Bader MJ,Gratzke C,Walther S,et al.The Poly Scope:a modular design,semidisposable flexible ureterorenoscope system[J].J Endourol,2010,24(7):1061-1066.DOI:10.1089/end.2010.0077.
9赵夭望,刘李,涂磊,等.经输尿管软镜钬激光碎石术治疗儿童肾结石和输尿管上段结石[J].临床小儿外科杂志,2013,12(6):435-438.DOI:10.3969/j.issn.1671-6353.2013.06.002.Zhao YW,Liu L,Tu L,et al.Flexible ureteroscope holmium laser lithotripsy for the treatment of children with kidney stones and upper ureteral calculus[J].J Clin Ped Sur,2013,12(6):435-438.DOI:10.3969/j.issn.1671-6353.2013.06.002.
10 Geavlete P,Multescu R,Geavlete B.Influence of pyelocaliceal anatomy on the success of flexible ureteroscopic approach[J].J Endourol,2008,22(10):2235-2239.DOI:10.1089/end.2008.9719.
2 Woodside JR,Stevens GF,Stark GL,et al.Percutaneous stone removal in children[J].J Urol,1985,134(6):1166-1167.DOI:10.1016/S0022-5347(17)47669-5.
3 Thiruchelvam N,Mostafid H,Ubhayakar G.Planning percutaneous nephrolithotomy using multidetector computed tomography urography,multiplanar reconstruction and three-dimensional reformatting[J].BJU Int,2005,95(9):1280-1284.DOI:10.1111/j.1464-410X.2005.05841_3.x.
4 Watterson JD,Soon S,Jana K.Access related complications during percutaneous nephrolithotomy:urology versus radiology at a single academic institution[J].J Urol,2006,176(1):142-145.DOI:10.1016/S0022-5347(06)00489-7.
5 Yamaguchi A,Skolarikos A,Buchholz NP,et al.Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5,537patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study[J].JEndourol,2011,25(6):933-939.DOI:10.1089/end.2010.0606.
6 Bultitude M,Smith D,Thomas K.Contemporary Management of Stone Disease:The New EAU Urolithiasis Guidelines for2015[J].Eur Urol,2016,69(3):486-484.DOI:10.1016/j.eururo.2015.08.010.
7 Multescu R,Geavlete B,Geavlete P.A new era:performance and limitations of the latest models of flexible ureteroscopes[J].Urolgy,2013,82(6):1236-1239.DOI:10.1016/j.urology.2013.07.022.
8 Bader MJ,Gratzke C,Walther S,et al.The Poly Scope:a modular design,semidisposable flexible ureterorenoscope system[J].J Endourol,2010,24(7):1061-1066.DOI:10.1089/end.2010.0077.
9赵夭望,刘李,涂磊,等.经输尿管软镜钬激光碎石术治疗儿童肾结石和输尿管上段结石[J].临床小儿外科杂志,2013,12(6):435-438.DOI:10.3969/j.issn.1671-6353.2013.06.002.Zhao YW,Liu L,Tu L,et al.Flexible ureteroscope holmium laser lithotripsy for the treatment of children with kidney stones and upper ureteral calculus[J].J Clin Ped Sur,2013,12(6):435-438.DOI:10.3969/j.issn.1671-6353.2013.06.002.
10 Geavlete P,Multescu R,Geavlete B.Influence of pyelocaliceal anatomy on the success of flexible ureteroscopic approach[J].J Endourol,2008,22(10):2235-2239.DOI:10.1089/end.2008.9719.