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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (4): 705-710. doi: 10.19723/j.issn.1671-167X.2020.04.021

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Application of preoperative three-dimensional image reconstruction in the treatment of ureteropelvic junction obstruction

Meng-meng ZHENG1,2,Guang-pu DING1,Wei-jie ZHU1,Kun-lin YANG1,Shu-bo FAN1,Bao GUAN1,Xin-fei LI1,Yu-kun CAI1,Jin-sheng ZHANG2,Xue-song LI1,△(),Li-qun ZHOU1   

  1. 1. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre,Beijing 100034, China
    2. Department of Urology, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
  • Received:2019-09-11 Online:2020-08-18 Published:2020-08-06
  • Contact: Xue-song LI E-mail:pineneedle@sina.com

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Abstract:

Objective: To investigate the value of preoperative three-dimensional image reconstruction in the treatment of ureteropelvic junction obstruction (UPJO). Methods: We reviewed data on 40 patients (22 male cases,and 18 female cases) diagnosed with UPJO in Peking University First Hospital from May 2017 to April 2019. The median age was 26.5 years (IQR 23.25-38.75) years. There were 11 patients complicated with ectopic vessels,14 patients with kidney stones,3 patients with horseshoe kidney,and 6 patients with obstruction after pyeloplasty. All the patients underwent preoperative enhanced CT scan,and the CT data were reconstructed into three-dimensional image models. The obstruction position of ureteropelvic junction and the relationship between ureteropelvic junction and blood vessels and organs were observed by three-dimensional models to assist planning surgery. Thirty-seven patients underwent laparoscopic pyeloplasty (including 3 cases combined with pyelolithotomy with flexible cystoscope,1 case combined with pyelolithotomy by sun-style cystoscope, 1 case with laparoscopic ureter resection and anastomosis,3 cases of laparoscopic pyeloplasty of horseshoe kidney), 2 patients underwent laparoscopic ventral onlay lingual mucosal graft ureteroplasty, and 1 patient underwent robot-assisted laparoscopic pyeloplasty. Results: Three-dimensional CT image clearly showed the relationship between the obstruction of ureteropelvic junction and blood vessels and organs after three-dimensional reconstruction. The type,diameter,position and direction of the ectopic vessels could be observed clearly before operation according to the three-dimensional reconstruction model,and the number,size,location and shape of renal calculi or other masses,the number of involved renal calyces and the anatomical distribution in the renal pelvis and calyces could be also evaluated preoperatively. After comprehensive analysis of the above information,individualized operation plans were performed on the patients,all the 40 cases were successfully completed with the surgery without any transfer to open surgery. The average operative time was (129.91±37.90) min (range: 75 to 273), the average blood loss was (48.1±78.0) mL (range: 10 to 400), the average hospitality was (5.04±1.99) d (range: 2 to 10), and the average postoperative drainage time was (3.8±1.4) d (range: 2 to 8). Conclusion: The preoperative three-dimensional image reconstruction has a high clinical value in the treatment of ureteropelvic junction obstruction, and it is of great help to assist surgery planning and is worthy of further clinical promotion and application.

Key words: Three-dimensional image reconstruction, Ureteropelvic junction obstruction, Pyeloplasty

CLC Number: 

  • R691.2

Table 1

clinical data analysis of 40 patients diagnosed with UPJO"

Items UPJO (n=40)
Operative time/min 129.91±37.90
Blood loss/mL 48.1±78.0
Drainage time/d 3.8±1.4
Hospitalization time/d 5.04±1.99

Figure 1

Three-dimensional image model of UPJO with ectopic vessels A, case 1, UPJO caused by renal crossing artery; B, case 3, the large gap between UPJ and two ectopic arteries; C,case 5, multiple arteries and veins clinging to the renal pelvis,located in the operation area; D,case 8, heterotopic vein in front of UPJ,which located in the surgical area."

Table 2

Plinical data analysis of patients diagnosed with UPJO with ectopic vessels"

Case Type of
ectopic vessel		 Number of
branches		 Spatial relationship
between UPJ		 Spatial distance
between UPJ		 Operation
procedures
1 Artery 1 In front of UPJ Near Retained
2 Artery 1 In front of UPJ Far Retained
3 Artery 2 Behind the UPJ Far Retained
4 Arteries and veins A: 1/V: 1 Behind the UPJ Far Retained
5 Arteries and veins A: 4/V: 3 In front of the renal pelvis Near Cut off
6 Artery 1 In front of UPJ Far Cut off
7 Arteries and veins A: 1/V: 1 In front of UPJ Near Retained
8 Vein 1 In front of UPJ Near Cut off
9 Artery 1 In front of UPJ Near Retained
10 Artery 1 In front of the renal pelvis Near Retained
11 Arteries and veins A: 3/V: 2 In front of the renal pelvis Near Retained

Figure 2

Three-dimensional model of UPJO with kidney stones A, the location and shape of urinary stone located in the lower calyces could be clearly identified when renal tissue and blood vessels were eliminated; B, the maximum length axis and the maximum diameter of the stone could be found and measured by adjusting the spatial orientation and angle in the 3D mode."

Figure 3

Three-dimensional image model of UPJO with horseshoe kidney and UPJO after pyeloplasty A, horseshoe kidney with UPJO, with many vessels around the isthmus of horseshoe kidney, which includes small arteries and a vein across the renal pelvis; B, UPJO after pyeloplasty, with rough upper ureteral segment."

[1] 黄强, 杨骥, 林先盛, 等. CT三维重建在肝门部胆管癌的诊疗中的应用价值[J]. 中国普通外科杂志, 2017,26(8):960-967.
[2] 中华医学会数字医学分会, 中国研究型医院学会数字医学临床外科专业委员会. 复杂性肝脏肿瘤三维可视化精准诊治专家共识[J]. 中国实用外科杂志, 2017,37(1):53-59.
[3] 李学松, 杨昆霖, 周利群. IUPU经腹腹腔镜肾盂成型术治疗成人肾盂输尿管连接处梗阻(附视频)[J]. 现代泌尿外科杂志, 2015,20(6):369-372.
[4] Yang K, Yao L, Li X, et al. A modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction[J]. Urology, 2015,85(1):263-267.
doi: 10.1016/j.urology.2014.09.031 pmid: 25530399
[5] Klingler HC, Remzi M, Janetschek G, et al. Comparison of open versus laparoscopic pyeloplasty techniques in treatment of uretero-pelvic junction obstruction[J]. Eur Urol, 2003,44(3):340-345.
[6] 贾晨尧, 陈柯, 刘奇, 等. 基于CT的肾脏可视化三维重建模型在肾蒂血管变异的肾癌根治术中的应用[J]. 广东医学, 2017,38(9):81-84.
[7] Wang Z, Qi L, Yuan P, et al. Application of three-dimensional visualization technology in laparoscopic partial nephrectomy of renal tumor: a comparative study[J]. J Laparoendosc Adv Surg Tech A, 2017,27(5):516-523.
pmid: 28186431
[8] Tolkach Y, Thomann S, Kristiansen G. Three-dimensional reconstruction of prostate cancer architecture with serial immunohistochemical sections: hallmarks of tumour growth, tumour compartmentalisation, and implications for grading and heterogeneity[J]. Histopathology, 2018,72(6):1051-1059.
pmid: 29323728
[9] Rydberg J, Kopecky KK, Tann M, et al. Evaluation of prospective living renal donors for laparoscopic nephrectomy with multisection CT: the marriage of minimally invasive imaging with minimally invasive surgery[J]. Radiographics, 2001,21(Supp1 1):S223-S236.
[10] Ukimura O. Image-guided surgery in minimally invasive urology[J]. Curr Opin Urol, 2010,20(2):136-140.
doi: 10.1097/MOU.0b013e3283362610
[11] 赵海岳, 叶雄俊, 陈伟男, 等. 腹腔镜肾盂成型术中异位血管的处理方法[J]. 北京大学学报(医学版), 2019,51(4):660-664.
[12] Berkman DS, Landman J, Gupta M. Treatment outcomes after endopyelotomy performed with or without simultaneous nephrolithotomy: 10-year experience[J]. J Endourol, 2009,23(9):1409-1413.
doi: 10.1089/end.2009.0379 pmid: 19694529
[13] 陈远波, 李虎林, 刘春晓, 等. 数字化肾结石三维模型的建立及虚拟手术仿真[J]. 南方医科大学学报, 2013,33(2):267-270.
[14] Li HL, Chen YB, Liu C, et al. Construction of a three-dimensional model of renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery[J]. World J Urol, 2013,31(6):1587-1592.
doi: 10.1007/s00345-012-0998-7 pmid: 23223963
[15] 杨昆霖, 李学松, 周利群. IUPU经腹腹腔镜联合膀胱软镜肾盂取石及肾盂成型术[J]. 泌尿外科杂志: 电子版, 2015,7(3):4-6.
[16] Simonato A, Gregori A, Lissiani A, et al. The tongue as an alternative donor site for graft urethroplasty: a pilot study[J]. J Urol, 2006,175(2):589-592.
[17] Singh PB, Das SK, Kumar A, et al. Dorsal onlay lingual mucosal graft urethroplasty: comparison of two techniques[J]. Int J Urol, 2010,15(11):1002-1005.
pmid: 18808427
[18] Xu YM, Feng C, Sa YL, et al. Outcome of 1-stage urethroplasty using oral mucosal grafts for the treatment of urethral strictures associated with genital lichen sclerosus[J]. Urology, 2014,83(1):232-236.
[19] Li B, Xu YJ, Hai B, et al. Laparoscopic onlay lingual mucosal graft ureteroplasty for proximal ureteral stricture: initial experience and 9-month follow-up[J]. Int Urol Nephrol, 2016,48(8):1275-1279.
doi: 10.1007/s11255-016-1289-9 pmid: 27115158
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