CN107591074A - A kind of Flexible ureteroscope simulation learning method made based on 3D printing - Google Patents
A kind of Flexible ureteroscope simulation learning method made based on 3D printing Download PDFInfo
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- CN107591074A CN107591074A CN201710791562.6A CN201710791562A CN107591074A CN 107591074 A CN107591074 A CN 107591074A CN 201710791562 A CN201710791562 A CN 201710791562A CN 107591074 A CN107591074 A CN 107591074A
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Abstract
The invention discloses a kind of Flexible ureteroscope simulation learning method made based on 3D printing, specifically comprise the following steps:Clinical information typing step, CTU information gatherings step, CTU information handling steps, 3D modeling step, 3D models set-up procedure, 3D modeling operative training steps;The invention provides one kind to shorten Flexible ureteroscope learning curve, strengthens practical operation, improves a kind of Flexible ureteroscope simulation learning method made based on 3D printing for the efficiency that masters a skill.
Description
Technical field
The present invention relates to medical field, and in particular, it is related to a kind of Flexible ureteroscope mould made based on 3D printing
Intend learning method.
Background technology
Calculi in urinary system is the common disease of Urology Surgery, frequently-occurring disease, and the people in the whole world about 5%~15% is with secreting according to statistics
Urinary system calculus disease.Flexible ureteroscope has been the primary treatment side for treating below 2cm kidney stones and ureter upper end calculus
One of formula, possess the features such as minimally invasive, safe and effective, used and paid attention to by domestic increasing Urology Surgery doctor.It is near several
Nian Lai, at home, the continuous growth carried out unit as Flexible ureteroscope is newly-increased and report clinical case number, more and more doctors
Raw and medical institutions understand and paid attention to the technology, imperative for the Fast Learning of the technology, grasp and popularization.
However, it is difficult to skillfully grasp, the problems such as Flexible ureteroscope is fragile, constrains its large-scale promotion application, and wherein
About 28% damage is due to that surgeon is improper to soft lens and laser operations caused.Its major reason is mainly as follows:A 1. side
Face Flexible ureteroscope learning curve is longer, and is more difficult to manipulate compared with ureterscopy.2. on the other hand, the training side of Flexible ureteroscope
Formula is limited and limitation be present, and in view of the safety problem of patient, the rare report that practical teaching training is carried out with patient
Road.3. further, since the problems such as ethics, cost and source, the mode of surgery training is carried out with animal or corpse to be obtained
Preferably promote and apply.Therefore, for beginner, rapid pipe soft lens of grasping is still a huge challenge.
At present, China's medical level, scientific and technological level, economic level relatively fall behind, and overall development imbalance be present, domestic
Urology Surgery endoscopic technic still follows traditional " Apprenticing model " mode, and this mode has many such as learning cycle is long, risk is big
Shortcoming, and Flexible ureteroscope training is carried out directly with patient, patient be present and be difficult to receive and the problems such as risk is larger.Therefore
There is expert to advocate that the modes such as Applied Physics training box and animal model carry out Flexible ureteroscope simulation surgery training.But either thing
Reason training box or animal, its anatomical structure still suffer from very big difference with lesion situation compared with real patient, therefore, dynamic
The Flexible ureteroscope operation simulated with thing, its effect can have a greatly reduced quality.At present, virtual reality simulator is to report both at home and abroad
The most Flexible ureteroscope operative training method in road.Xiao Chenglin etc. is inquired into virtual reality simulator and driven in the wrong direction in beginner using soft
Property ureteroscopic treatment kidney stone after effect, as a result display virtual real simulator can effectively help beginner improve utilize
The technical ability of soft antidromicity ureteroscopic treatment kidney stone.Blankstein etc. has also inquired into virtual reality simulator in ureter
Application in soft lens simulated training, and think that ureteroscope virtual simulator can improve Flexible ureteroscope dummy level.It is but virtual
Reality simulator is expensive, is not appropriate for promoting the use of a large area.Therefore, in order to promote Flexible ureteroscope this technology, I
Need badly and find a kind of cost-effective simulation learning mode.
The content of the invention
Instant invention overcomes the deficiencies in the prior art, there is provided one kind shortens Flexible ureteroscope learning curve, and enhancing is actual
Operation, improve a kind of Flexible ureteroscope simulation learning method made based on 3D printing for the efficiency that masters a skill.
In order to solve the above-mentioned technical problem, technical scheme is as follows:
A kind of Flexible ureteroscope simulation learning method made based on 3D printing, is specifically comprised the following steps:
101)Clinical information typing step:Sufferer Data Enter, described information include age, sex, the length of education enjoyed, morbidity year
Age, the course of disease;The course of disease is determined according to the imageological examination of sufferer respectively by specialist and the doctor of above rank qualification
The course of disease of sufferer;
102)CTU information gathering steps:Allow step 101)The sufferer of institute's typing drunk water under fasting conditions 200ml fill enteron aisle,
Scanned again by CTU at upper pole of kidney to pubic symphysis, and from the beginning lateral sufficient side scanning, the parameter of the scanning are arranged to thickness
5mm, layer are away from for 5mm;It is unenhanced first to carry out full urinary tract, is then contrasted using high pressure injector from antecubital vein injection nonionic
Agent, total amount are 80ml to 100ml, and injection speed is 2.0 ml/S to 2.5 ml/S;In the injection nonionic contrast medium
Afterwards, and cross-section bit image information is gathered;The CTU is urography;
103)CTU information handling steps:By step 102)The data obtained information, use medical image algorithm platform and 3 D medical
Image data processing platform 3DMed, to handle data message, and kidney peripheral adipose tissue is removed, the removal kidney
Dirty peripheral adipose tissue need to reach more than 98%, and noise reduction, smooth excessiveness and fine fill method are used to adipose tissue forntier region
Processing, if removal is below standard, can jump out prompting frame, so as to select to continue automatic business processing or artificial selection as needed, come
Kidney peripheral adipose tissue is removed, the automatic business processing, it identifies that choosing kidney peripheral adipose tissue can identify than the last time
The standard of selection reduces by 20%, and until clearance is up to standard, automatic business processing can just stop;Retain and kidney is rebuild according to data message
Dirty, aggregation system, bladder and ureter, and rip cutting, the reconstruction of crosscutting different section are carried out to urinary system model, so that it is determined that
Stone location and its relation with surrounding structure, then all data messages are carried out with further noise reduction, smooth and fine
Filling is handled;
104)3D modeling step:By step 103)Information transfer after processing to 3D printer, and using elastomer material as
1 is printed by 3D printer in basis:1 kidney, ureter and bladder integration urinary system model;
105)3D model set-up procedures:To step 104)The 3D models built, it is straight to carry out ureterscopy intubation, Flexible ureteroscope
Mirror, the inspection of Flexible ureteroscope kidney aggregation system, Flexible ureteroscope rubble operation progress 3D model recovery condition evaluations are accessed, and it is right
The 3D models at improper place carry out parameter adjustment and improved with material selection;Reach the standard for restoring sufferer urinary system situation, institute
Standard is stated to carry out CTU scan datas and step 102 to 3D models)The error of scan data is 2%;If comparing result shows
Show that error is more than 2%, can jump out selection prompting frame, selection continues adjusting parameter and still terminated, and carry out by specialist and more than
The physician in view 3D models of rank qualification are assessed;
106)3D modeling operative training steps:By learner in step 105)The 3D models of foundation carry out ureterscopy and inserted
Pipe, Flexible ureteroscope directly enter mirror, the inspection of Flexible ureteroscope kidney aggregation system, the operation of Flexible ureteroscope rubble study, by institute
The specific steps for having operation are recorded.
Further, 3D is arrived in information storage of the described information including age, sex, the length of education enjoyed, age of onset, the course of disease
On the memory of printer.
Further, the 3D printer uses ProJet5500 type 3D printers.
Further, the consideration data of the highly elastic material are elasticity, intensity and hardness.
Further, the 3D model recoveries condition evaluation includes objective evaluation and subjective evaluation, and the objective evaluation is
Mirror, the inspection of Flexible ureteroscope kidney aggregation system, urine output are directly entered by ureterscopy intubation, Flexible ureteroscope according to 3D models
After the operation of pipe soft lens rubble, the depth of its mark is assessed for parameter, the subjective evaluation, by specialist and with
The doctor of upper rank qualification, operated according to experience itself to carry out assessing 3D model recovery situations.
Further, the ureterscopy intubation, Flexible ureteroscope directly enter mirror, the inspection of Flexible ureteroscope kidney aggregation system
Look into, Flexible ureteroscope rubble operation when, gravity sensor, gyro sensor, acceleration transducer are both provided with instrument,
So as to judge whether the elasticity at each position of 3D models, intensity, hardness reduce sufferer present situation.
Advantage is the present invention compared with prior art:
1, the present invention utilizes 3D printing technique, with reference to the three-dimensional reconstruction data such as CTU, MRU of patient, is printed using elastomer
Go out the 1 of patient's urinary system:1 model, and use it for Flexible ureteroscope Operation training.
2, the present invention can not only more really simulate the urinary system dissection of patient, moreover it is possible to it is different to print merging renal anatomy
The individuation urinary system model for the particular patients 's such as often, calculus lesion, ureteral distortion be narrow.In this individuation 3D printing model
On be trained, can allow young doctors more safety convenient, fast and effectively grasp Flexible ureteroscope, be advantageous to shorten ureter
Soft lens learning curve, it is final to promote Flexible ureteroscope technology widely to be promoted national so as to accelerate the growth of young doctors.
3, the present invention helps urological surgeon preferably to grasp the special Flexible ureteroscope operation for dissecting patient, so as to drop
Low iatrogenic surgical injury, and more detailed operation plan can be made, more accurately assess risk that may be present in art.
4, it is, even if after shaping, still to have certain flexible the characteristics of the highly elastic material maximum that the present invention uses
Property, extraneous firmly extruding, distortion are supported, is even pullled, and resilient enough, resilience effect are very outstanding, and possess anti-
Water function.Using highly elastic material carry out print urinary system model, can more really react urinary system it is soft, it is yielding and
The characteristics of cavity content is liquid, it is more suitable for us and carries out Flexible ureteroscope simulation operation.
Brief description of the drawings
Fig. 1 is a kind of schematic diagram of the Flexible ureteroscope simulation learning method made based on 3D printing of the present invention.
Embodiment
The present invention is further described with reference to the accompanying drawings and detailed description.
As shown in figure 1, a kind of Flexible ureteroscope simulation learning method made based on 3D printing, specifically includes following step
Suddenly:
101)Clinical information typing step:Sufferer Data Enter, described information include age, sex, the length of education enjoyed, morbidity year
Age, the course of disease, and by information storage to the memory of 3D printer.The course of disease is by specialist and above rank qualification
Doctor, determine the course of disease of sufferer according to the imageological examination of sufferer respectively.
102)CTU information gathering steps:Allow step 101)The sufferer of institute's typing drunk water under fasting conditions 200ml fill intestines
Road, to reduce gas artifact and reduce infringement of the contrast medium to kidney.Scanned again by CTU at upper pole of kidney to pubic symphysis, and
From the beginning lateral sufficient side scanning, the CTU carry out unenhanced and enhancing to patient using 64 slices spiral CTs and checked.The parameter of the scanning
Thickness 5mm, layer are arranged to away from for 5mm.It is unenhanced first to carry out full urinary tract, then using high pressure injector from antecubital vein injection it is non-from
Subtype contrast medium, total amount are 80ml to 100ml, and injection speed is 2.0 ml/S to 2.5 ml/S.The 25- after injection of contrast agent
30S is the cortex phase, 60 S are the medullary substance phase, 15 rain are the excretion phase, by stages interior herein to be acquired cross-section bit image.The CTU
For urography.Thin reconstruction is carried out after the end of scan, thickness 1.25mm, 1.25 mm of interval are rebuild, by volume thin layer data
In the memory of incoming 3D printer.
103)CTU information handling steps:By step 102)The data obtained information, use medical image algorithm platform and three-dimensional
Medical image data processing platform 3DMed, to handle data message, and kidney peripheral adipose tissue is removed, it is described to go
Except kidney peripheral adipose tissue need to reach more than 98%, to adipose tissue forntier region using noise reduction, smooth excessiveness and fine filling
Method processing, if removal is below standard, can jump out prompting frame, so as to select to continue automatic business processing or artificial choosing as needed
Take, to remove kidney peripheral adipose tissue, the automatic business processing, it identifies that selection kidney peripheral adipose tissue can be than the last time
The standard that identification is chosen reduces by 20%, and until clearance is up to standard, automatic business processing can just stop.Retain and according to data message weight
Kidney, aggregation system, bladder and ureter are built, and rip cutting, the reconstruction of crosscutting different section are carried out to urinary system model, so as to
Determine stone location and its relation with surrounding structure, then all data messages are carried out further noise reduction, it is smooth and
Fine filling processing.The 3D printing STL formatted files of last outputting standard.
104)3D modeling step:By step 103)Information transfer after processing is to 3D printer, and with elastomer material
By 3D printer based on material, 1 is printed:1 kidney, ureter and bladder integration urinary system model.The 3D is beaten
Print machine uses ProJet5500 type 3D printers.The consideration data of the highly elastic material are elasticity, intensity and hardness.
105)3D model set-up procedures:To step 104)The 3D models built, it is soft to carry out ureterscopy intubation, ureter
Mirror directly enters mirror, the inspection of Flexible ureteroscope kidney aggregation system, Flexible ureteroscope rubble operation progress 3D model recovery condition evaluations,
And parameter adjustment and material selection improvement are carried out to the 3D models at improper place.It is objective that the 3D model recoveries condition evaluation includes
Assess and subjective evaluation, the objective evaluation be according to 3D models by ureterscopy intubation, Flexible ureteroscope directly enter mirror,
After the inspection of Flexible ureteroscope kidney aggregation system, the operation of Flexible ureteroscope rubble, the depth of its mark is assessed for parameter,
The subjective evaluation, by specialist and the doctor of above rank qualification, operated according to experience itself to be assessed
3D model recovery situations.Reach the standard for restoring sufferer urinary system situation, the standard scans number to carry out CTU to 3D models
According to step 102)The error of scan data is 2%;If comparing result display error is more than 2%, selection prompting frame can be jumped out,
Selection continues adjusting parameter and still terminated, and commented by the physician in view 3D models of specialist and above rank qualification
Estimate.The subjective evaluation is specially:10 Urology Surgery specialists are selected, are engaged in Urology Surgery professional work more than 3 ~ 5 years,
The Flexible ureteroscope operation operator experience of more than 30 is provided with, this 3D model is operated.3D is fixed in operating desk to beat
Stamp type, ureterscopy intubation is carried out by above-mentioned medical practitioner, Flexible ureteroscope directly enters mirror, Flexible ureteroscope kidney collection syzygy
The operations such as system inspection, Flexible ureteroscope rubble.After operation terminates, 3D models are assessed, assessing content includes:1st, it is and true
The similitude of patient;2nd, the practicality of each ureteroscope operation;3rd, area for improvement, then and assessed according to expert to 3D
Printer model carries out parameter adjustment and material improvement, is suitably available for doctor that Flexible ureteroscope simulation is repeated until printing
The 3D urinary system models of operation technique.
106)3D modeling operative training steps:By learner in step 105)It is hard that the 3D models of foundation carry out ureter
Mirror intubation, Flexible ureteroscope directly enter mirror, the inspection of Flexible ureteroscope kidney aggregation system, the operation of Flexible ureteroscope rubble study,
The specific steps of all operations are recorded.The ureterscopy intubation, Flexible ureteroscope directly enter mirror, Flexible ureteroscope
The inspection of kidney aggregation system, Flexible ureteroscope rubble operation when, be both provided with instrument gravity sensor, gyro sensor,
Acceleration transducer, so as to judge whether the elasticity at each position of 3D models, intensity, hardness reduce sufferer present situation, in the hope of more
Objective and fair.20 this center surgical specialties postgraduates, rotation doctor or Undergraduate Practice life are specially selected, in addition to Undergraduate Practice
Without clinical experience, before without any intracavitary Clinical Urology(Hereinafter referred to as beginner).All 20 beginners are random
It is divided into 2 groups(Operation group and control group), two groups carry out Flexible ureteroscope respectively on the urinary system model of 3D printing and directly enter
Mirror, the inspection of Flexible ureteroscope kidney aggregation system, Flexible ureteroscope rubble etc. operate, and are assessed first.
The index of assessment includes subjective and objective two aspect:Wherein subjective aspect is that 10 Urology Surgery specialists are carried out
Assess, assessing content includes reaction to tissue, the qualification of action, the degree of stability in the visual field, kidney aggregation system structure
Several aspects such as degree of understanding, surgical procedure general impression, wherein each aspect is from being respectively 1 according to the fine or not degree of performance
Point, 2 points, 3 points, 4 points, 5 points (1 points to be worst, 5 points are best);Objective aspects include it is each operation test the deadline,
The index such as stone success rate, rubble time is sought, and calculates the scoring total score of each beginner.
After the completion of assessing first, 10 beginners of operation group receive to be up to 2 h mould daily in ensuing 1 middle of the month
Intend device operation training, directly enter mirror including ureterscopy intubation, Flexible ureteroscope, Flexible ureteroscope kidney aggregation system is examined
Look into and the operation such as Flexible ureteroscope rubble.Control group beginner does not do any Flexible ureteroscope simulated training, only carries out tradition and " learns
Empty formula " mode clinical learning.Assessed again with above-mentioned module after 1 month, twice with simulation before and after two groups of beginners of collection
Device carries out the score data of Flexible ureteroscope operation and contrasted.Pass through Flexible ureteroscope service condition twice before and after beginner
Scored, the horizontal gain effect of Flexible ureteroscope operation is being improved so as to contrast 3D printing model.
Preferably, the FullCure720 transparent soft moulding materials of the material of the 3D modeling.
Described above is only the preferred embodiment of the present invention, it is noted that for the ordinary skill people of the art
Member, without departing from the inventive concept of the premise, can also make some improvements and modifications, these improvements and modifications also should be regarded as
In the scope of the present invention.
Claims (6)
- A kind of 1. Flexible ureteroscope simulation learning method made based on 3D printing, it is characterised in that specifically comprise the following steps:101)Clinical information typing step:Sufferer Data Enter, described information include age, sex, the length of education enjoyed, morbidity year Age, the course of disease;The course of disease is determined according to the imageological examination of sufferer respectively by specialist and the doctor of above rank qualification The course of disease of sufferer;102)CTU information gathering steps:Allow step 101)The sufferer of institute's typing drunk water under fasting conditions 200ml fill enteron aisle, Scanned again by CTU at upper pole of kidney to pubic symphysis, and from the beginning lateral sufficient side scanning, the parameter of the scanning are arranged to thickness 5mm, layer are away from for 5mm;It is unenhanced first to carry out full urinary tract, is then contrasted using high pressure injector from antecubital vein injection nonionic Agent, total amount are 80ml to 100ml, and injection speed is 2.0 ml/S to 2.5 ml/S;In the injection nonionic contrast medium Afterwards, and cross-section bit image information is gathered;The CTU is urography;103)CTU information handling steps:By step 102)The data obtained information, use medical image algorithm platform and 3 D medical Image data processing platform 3DMed, to handle data message, and kidney peripheral adipose tissue is removed, the removal kidney Dirty peripheral adipose tissue need to reach more than 98%, and noise reduction, smooth excessiveness and fine fill method are used to adipose tissue forntier region Processing, if removal is below standard, can jump out prompting frame, so as to select to continue automatic business processing or artificial selection as needed, come Kidney peripheral adipose tissue is removed, the automatic business processing, it identifies that choosing kidney peripheral adipose tissue can identify than the last time The standard of selection reduces by 20%, and until clearance is up to standard, automatic business processing can just stop;Retain and kidney is rebuild according to data message Dirty, aggregation system, bladder and ureter, and rip cutting, the reconstruction of crosscutting different section are carried out to urinary system model, so that it is determined that Stone location and its relation with surrounding structure, then all data messages are carried out with further noise reduction, smooth and fine Filling is handled;104)3D modeling step:By step 103)Information transfer after processing to 3D printer, and using elastomer material as 1 is printed by 3D printer in basis:1 kidney, ureter and bladder integration urinary system model;105)3D model set-up procedures:To step 104)The 3D models built, it is straight to carry out ureterscopy intubation, Flexible ureteroscope Mirror, the inspection of Flexible ureteroscope kidney aggregation system, Flexible ureteroscope rubble operation progress 3D model recovery condition evaluations are accessed, and it is right The 3D models at improper place carry out parameter adjustment and improved with material selection;Reach the standard for restoring sufferer urinary system situation, institute Standard is stated to carry out CTU scan datas and step 102 to 3D models)The error of scan data is 2%;If comparing result shows Show that error is more than 2%, can jump out selection prompting frame, selection continues adjusting parameter and still terminated, and carry out by specialist and more than The physician in view 3D models of rank qualification are assessed;106)3D modeling operative training steps:By learner in step 105)The 3D models of foundation carry out ureterscopy and inserted Pipe, Flexible ureteroscope directly enter mirror, the inspection of Flexible ureteroscope kidney aggregation system, the operation of Flexible ureteroscope rubble study, by institute The specific steps for having operation are recorded.
- 2. a kind of Flexible ureteroscope simulation learning method made based on 3D printing according to claim 1, its feature are existed In:Described information arrives the memory of 3D printer including age, sex, the information storage of the length of education enjoyed, age of onset, the course of disease On.
- 3. a kind of Flexible ureteroscope simulation learning method made based on 3D printing according to claim 1, its feature are existed In:The 3D printer uses ProJet5500 type 3D printers.
- 4. a kind of Flexible ureteroscope simulation learning method made based on 3D printing according to claim 1, its feature are existed In:The consideration data of the highly elastic material are elasticity, intensity and hardness.
- 5. a kind of Flexible ureteroscope simulation learning method made based on 3D printing according to claim 1, its feature are existed In:The 3D model recoveries condition evaluation includes objective evaluation and subjective evaluation, and the objective evaluation is passed through according to 3D models Ureterscopy intubation, Flexible ureteroscope directly enter mirror, the inspection of Flexible ureteroscope kidney aggregation system, the operation of Flexible ureteroscope rubble Afterwards, the depth of its mark is that parameter is assessed, and the subjective evaluation, passes through specialist and the doctor of above rank qualification Teacher, operated according to experience itself to carry out assessing 3D model recovery situations.
- 6. a kind of Flexible ureteroscope simulation learning method made based on 3D printing according to claim 5, its feature are existed In:The ureterscopy intubation, Flexible ureteroscope directly enter mirror, the inspection of Flexible ureteroscope kidney aggregation system, Flexible ureteroscope When rubble operates, gravity sensor, gyro sensor, acceleration transducer are both provided with instrument, so as to judge the 3D Whether elasticity, intensity, the hardness at each position of model reduce sufferer present situation.
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