摘要
目的 探讨根据上尿路结石患者CT检查资料建立的虚拟输尿管镜（virtualureteroseopy,vU）在辅助输尿管软镜（flexible ureteroscopy,FURS）手术时的有效性.方法 2015年6月至2016年1月收治的23例肾结石患者,男15例,女8例.年龄31 ～79,平均（54.7±12.5）岁.单侧肾结石21例,双侧2例.结石总负荷10～34 mm,平均（19.0±6.2）mm,其中下盏结石负荷平均（8.4±5.7）mm.结石数量1～5枚,平均（2.7±1.2）枚.根据患者CT尿路造影（computerizedtomography urography,CTU）检查数据,采用Crusher软件建立VU.选取5名FURS独立操作例数＞100例的专家术前查阅CTU结果及采用VU模拟探查,然后进行FURS,术后以Likert量表（10分制）对VU做出表面和内容效度评价.选取20名FURS独立操作例数≤5例的初学者及上述5名专家,先后观察由23例病例中抽取的2例患者（3个肾脏）的CTU结果并采用VU模拟探查,比较专家及初学者分别通过CTU和VU观察的肾盏、结石数量差异.结果 5名专家评价VU的总体有效性（7.6±0.5）分,图像逼真性（7.6±0.5）分,集合系统细节（8.4±0.5）分,结石描述（8.4±0.5）分,对规划和培训意义（8.0±0.7）分.初学者通过CTU和VU观察的肾盏数量分别为（16.7±3.7）个和（24.6±1.8）个,结石数量分别为（4.9±1.4）枚和（8.2±1.3）枚,差异均有统计学意义（均P＜0.05）.专家通过CTU和VU观察的肾盏数量分别为（22.4±3.0）个和（25.4±0.5）个,结石数量分别为（8.0±0.7）枚和（8.8±0.4）枚,差异均无统计学意义（均P＞0.05）.初学者通过CTU观察的肾盏及结石数量明显少于专家（均P ＜0.05）,通过VU观察的肾盏及结石数量两者差异无统计学意义（P＞0.05）.结论 通过采集上尿路结石患者的CTU数据可以快速形成VU.与CTU比较,VU有效地提高了初学者对FURS相关肾内结构和结石信息的掌握程度,其表面和内容效度得到专家肯定.
Objective To establish computer assisted virtual ureteroscopy （VU） through data from computerized tomography urography （CTU） of patients with renal stones and make validation of effectiveness.Methods From June of 2015 to January of 2016,23 cases of renal stones cases was selected by 5 experts in 3 different centers.There were 21 unbilateral cases and 2 bilateral cases.The age ranged from 31 to 79（54.7 ± 12.5）.Mean stone burden was （19.0 ± 6.2） mm.Stone number ranged from 1 to 5 （2.7 ± 1.2）.VU generation was accomplished by specialized software （Crusher） with incorporating CTU data.After patientspecific VUs were presented to the experts,and the FURS surgeries were all finished successfully,face and content validations about VU using modified Likert questionnaire ordinal 10-point rating scales were made.20 trainee were selected to do the flexible ureteroscopy lithotripsy with assistance of VU.After observation of CTU and VU,the numbers of renal calyces and stones found by the experts and trainees were recorded.The statistical analysis were made before and after observation of VU between the experts and trainees.Result Face and content validation of VU：overall usefulness 7.6 ± 0.5,graphics 7.6 ± 0.5,intrarenal collecting system 8.4 ± 0.5,stone details 8.4 ± 0.5,usefulness in surgical planning and training 8.0 ± 0.7.Significant improvement was found when the trainees doing the surgery with the help of VU.Compared with using CTU only,VU could help the trainees had better understanding of intrarenal structure and stone information [the number of calyces （16.7 ±3.7）vs.（24.6 ± 1.8）,P 〈0.001;the number of stones （4.9 ± 1.4）vs.（8.2 ± 1.3）,P 〈0.001].Before observation of VU,trainees found much fewer calyces and stones compared with experts （P =0.004 and P 〈 0.001 respectively）.However,this gap disappeared after VU observation （P =0.327 and 0.292 respectively）.Conclusions Establishing computer assisted VU through CTU data from renal stone patients is feasible and rapid.VU can significantly improve trainee＇s view of intrarenal collecting system and stone information before practicing FURS.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第3期206-210,共5页
Chinese Journal of Urology
关键词
虚拟输尿管镜
辅助
输尿管软镜碎石术
有效性
评估
Virtual ureteroscopy
Computer assisted
Flexible ureteroscopy lithotripsy
Validation
Effectiveness
