| Background:Urinary calculi are the most common diseases in urology and are a serious threat to human health.With the development of technology,intracavitary minimally invasive lithotripsy,such as PCNL,fURS,has become the first line of treatment for urinary calculi.Although PCNL has a high stone free rate,its complications,such as hemorrhage and peripheral organ injury,are still prominent problems.It is closely related to the choice of puncture channel.How to choose a reasonable channel for individualized and reduce complications.The essential fURS operates through natural channels and is highly regarded for its almost non-invasive and repeatable advantages.However,the stone free rate is not good,and the durability of the soft mirror is not high,fragile,and expensive.With the extensive development of minimally invasive lithotripsy in the lumen,the occurrence of urosepsis has also received increasing attention.Insidious onset,rapid progress,high mortality,early diagnosis and intervention is the most effective measure to reduce patient mortality.Existing infection indicators such as WBC,CRP,etc.,have poor effects on early diagnosis of urosepsis.In this study,we established a three-dimensional reconstruction and a 3D printed model to explore the application of PCNL puncture and fURS to find stones,providing a basis for patients to develop individualized treatment plans.Perioperative PCT monitoring is used for early diagnosis and treatment of urosepsis and to guide the use of antibiotics in order to increase the stone free rate and reduce the incidence of complications.Application of CT three-dimensional reconstruction and 3D printing model in minimally invasive lithotripsyPart One CT three-dimensional reconstruction and the establishment of 3D printing modelObjective: To explore the possibility of three-dimensional reconstruction of patients(kidney,renal pelvis,renal pelvis,blood vessels,stones and adjacent organs)using CT data and 3D printing.Methods: CT data of patients were copied,and the kidney stone model was reconstructed in three dimensions by Mimics software,and a 3D model was made using a Makerbot Replicator 3D printer.Results: In the Mimics software,the patient’s CT 3D model was successfully reconstructed in three dimensions,with a clear structure and matched with a 3D printer to complete 3D printing.Part Two Role of three-dimensional reconstruction and 3D printed kidney stone model in PCNL punctureObjective: To investigate the value of CT three-dimensional reconstruction and 3D printed model in PCNL puncture.Methods: 102 patients with≥2cm renal calculi admitted to the Department of Urology,Southwest Hospital of Army Medical University from January to October 2013 were divided into experimental group(51 cases)and control group(51 cases).In the 3D reconstruction and 3D printed kidney stone model,preoperative planning,positioning puncture point,measuring puncture depth,angle,etc.;control group conventional CTU preoperative planning.Under general anesthesia,the patient underwent PCNL surgery according to preoperative planning.KUB was reviewed 7 days after surgery to find out whether there was any residual stone and whether it was a second stage.Data such as general patient data,stone characteristics,operation time,hospital stay,first-stage SFR,and complications were collected.Results: The operation time of the experimental group was 61±19min,the stone free rate in the first stage was 92.3%,postoperative fever(≥38.5°C)in 2 cases,and urosepsis in 1 case.The operation time of the control group was 79±24min,the SFR was 82% in the first stage,6 cases were postoperative fever(≥38.5°C),and 4 cases were transfused.One of them was treated with delayed renal artery embolization for hemostasis 2 cases.After treatment with anti-infective,symptomatic and other treatment,the patient recovered and was discharged.There were significant differences in operative time,SFR,blood transfusion rate,and total complication rate between the two groups(p<0.05).Conclusion: Three-dimensional reconstruction and 3D printed kidney stone model facilitate the PCNL individualized puncture,improve SFR and reduce the complication rate.Part Three: Application of 3D printed renal pelvis model in the treatment of lower pole stone with fURSObjective: To investigate the value of 3D printed renal pelvis model in the treatment of lower pole stone with fURS.Methods: 122 patients with ≤2 cm lower pole stone admitted to the Department of Urology,Southwest Hospital of the Army Medical University from February 2014 to August 2015 were divided into experimental group(61 cases)and control group(61 cases).Reconstruction of renal pelvis was performed in 3D.The operation of finding the stone in the simulation of the renal pelvis model was performed to observe whether the fURS can find the stones.The control group underwent preoperative planning for CTU.On the second day after surgery,the plain film was reviewed to understand the position of the double J tube and the residual stone(SFR1d).The patient was discharged from the hospital on the third day without any complications.After one month,the patient returned to the hospital to evaluate the residual stone(SFR1m).If the residual stone fragments are large/cannot be discharged by himself,consider the second phase fURS.In the third month after the operation,the patient was evaluated for the stone removal(SFR3m),and the SFR was calculated by the stone fragments≤4 mm.The patient’s general data,stone characteristics,operation time,hospital stay,SFR,and complications were counted.Results: The experimental group successfully completed the three-dimensional reconstruction and 3D printing of the renal pelvis,and successfully completed the operation of the preoperative simulated fURS to find stones on the 3D printing model.The operation time was 42.2±10.4min,SFR1 d was 50.8%,SFR1 m was 73.8%,SFR3 m was 93.4%,and the complication rate was 4.9%.The control group operation time was 61.2±19.4min,SFR1 d was 49.2%,SFR1 m was 62.3%,SFR3 m was 80.3%,the complication rate was 16.4%.The experimental group was significantly shorter than the control group,with high SFR and low complication rate(p<0.05).Conclusion: Preoperative application of 3D printed model to simulate fURS is safe and effective,which can improve the operation proficiency,shorten the operation time and reduce the risk of postoperative fever.Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomyObjective: To evaluate the value of procalcitonin(PCT)as an early marker for diagnosis and differentiation of without urosepsis,urosepsis,severe urosepsis,and uroseptic shock following PCNL and the ability of PCT to assess the effectiveness of antibiotic therapy in patients with urosepsis.Methods: From June 2012 to August 2013,267 patients undergoing PCNL for renal calculi,and who fulfilled selection criteria,were recruited into our study.The patients’ medical records were reviewed retrospectively.One of selection criteria was the scores of PCT and WBC were collected at operative day,postoperative day one,day two,day three,day five and day seven.Results: The area under the ROC curve for the prediction of urosepsis was 0.960 for PCT and 0.634 for WBC.PCT concentrations were higher in patients with uroseptic shock versus severe urosepsis versus urosepsis versus without urosepsis following PCNL.WBC values showed no significant difference between patients with urosepsis,severe urosepsis and uroseptic shock following PCNL.With time,in patients with successfully treated urosepsis following PCNL,the PCT concentrations significantly declined and kept decreasing from postoperative day two to postoperative day seven and the WBC scores showed no significant change over the first postoperative 2 days and were decreased only after postoperative day three.Conclusion: PCT appears to be a useful early marker to diagnosis and discriminate urosepsis,severe urosepsis and uroseptic shock following PCNL.Daily PCT measurements may be a valuable tool in monitoring the effectiveness of antibiotic therapy in urosepsis following PCNL. |
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