混合现实辅助导航联合超声与传统超声在PCNL中引导穿刺效果的比较

目的探讨超声联合混合现实在经皮肾镜碎石取石术（PCNL）的应用价值。 方法将2019年3月至2021年3月在北部战区总医院收治的100例肾结石患者采用随机信封法分组，实验组和对照组各50例，实验组接受超声联合混合现实辅助导航经皮肾穿刺，对照组采用传统CT图像阅片并结合术中超声定位实施PCNL。术者分别使用HoloLens眼镜（实验组）或CT图像（对照组）向患者及家属陈述病情，制定手术方案。运用t检验、Mann-Whitney U检验及χ²检验比较两组患者的穿刺准确性、穿刺时间和术中出血量、住院时间、Ⅰ期结石清除率、术后并发症等临床指标及一般资料。所有手术均由经验丰富的泌尿外科医师进行。 结果所有患者均顺利完成手术。实验组和对照组比较，1针穿刺准确性为90% vs 74.0%，穿刺时间中位数为8.3（7.3，8.7）] vs 9.4（8.6，10.8）]min，手术时间中位数为75（45，100）] vs 88（65，122）]min，术中出血量中位数为30（20，50）] vs 40（30，50）]ml，Hb改变值中位数为10.0（6.0，17.5）] vs 18.0（14.2，26.5）]g/L，差异均有统计学意义（P<0.05），提示使用超声联合混合现实与传统手术相比，穿刺准确性高，穿刺时间短，术中出血量少，术后Hb改变值低，且手术时间短。混合现实组和对照组患者在年龄、性别、BMI、结石大小、结石侧别、STONE评分、住院时间及I期结石清除率等方面差异无统计学意义（P>0.05）。 结论超声联合混合现实辅助导航符合精确穿刺理念，穿刺准确性高，耗时及出血量少，在PCNL中辅助定位穿刺是有帮助的，安全可行，可应用于临床，值得推荐。

Comparison of the effects of mixed reality assisted navigation combined with ultrasound and traditional ultrasound in guided puncture in PCNL

ObjectiveTo explore the application value of ultrasound combined with mixed reality in percutaneous nephrolithotomy (PCNL). MethodsOne hundred patients with renal calculi treated in the Northern Theater General Hospital from March 2019 to March 2021 were randomly divided into two groups: the experimental group (n=50) and the control group (n=50). The experimental group received ultrasound combined with reality-assisted percutaneous renal puncture, while the control group received traditional CT image reading combined with intraoperative ultrasound localization to perform PCNL. HoloLens glasses (experimental group) or CT images (control group) were used to state the patient's condition and make the operation plan to the patients and their family members. The clinical indexes and general data such as puncture accuracy, puncture time, intraoperative blood loss, hospital stay, stage I stone clearance rate and postoperative complications were compared between the two groups by t-test, Mann-WhitneyU test and χ² test . All operations were performed by experienced urologists. ResultsAll patients completed the operation successfully. The accuracy of the first puncture in the experimental group and control group was 90% vs 74.0 %, the median puncture time was 8.3(7.3, 8.7)] vs 9.4(8.6, 10.8)] min, the median operative time was 75(45, 100)] vs 88(65, 122)] min, the median intraoperative blood loss was 30(20, 50)] vs 40(30, 50)]ml, and the median change value of Hb was 10.0(6.0, 17.5)] vs 18.0(14.2, 26.5)] g/L, and all the differences were statistically significant. These results suggest that compared with the traditional operation, the ultrasound combined with mixed reality has higher puncture accuracy, shorter puncture time, less intraoperative blood loss, lower postoperative Hb change, and shorter operation time. There was no significant difference in age, sex, BMI, stone size, stone side, STONE score, hospital stay and stage I stone clearance rate between the mixed reality group and the control group. ConclusionUltrasound combined with mixed reality assisted navigation accords with the concept of accurate puncture, high puncture accuracy, less time consuming and bleeding, and the application of assisted location puncture in PCNL is helpful, safe and feasible, and can be used in clinic, which is worth recommending.