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3.2穿刺
机器人的应用
对于经皮肾脏穿刺的机器人系统,国外早已有相关报道。1997年Johns Hopkins小组就成功发明并开展了机器人模拟穿刺建立通道的实验
[30]。在猪肾脏实验中,由于
穿刺针的偏移和肋骨的阻挡,穿刺目标肾盏的命中率仅有50%。改进到PAKY-RCM系统,穿刺目标肾盏的命中率达到
87%[24]。我国余月等[25]使机械臂在固定的水果上试验,做到在固定的物件上选定的多点进行穿刺,后成功开发出穿刺机器人样机,穿刺离体
猪肾盏成功率达到67%[26]。在
B超引导下对兔肾盏进行穿刺,成功率达到50%。
4穿刺培训系统的进展
目前关于穿刺技术的培训主要系生物模拟器和非生物模拟器。Rock等[27]通过聚乙烯材料的
手套制作了一个非生物模拟器。方法是向手套
内注水,并捆紧好手套口,利用内含水的手指模拟各积水肾盏,在超声引导下进行穿刺。Imkamp等(28]则通过一个成年猪肾进行模拟。通过一
个F18的尿管与与肾盂相连,向尿管内注水或造影剂,在超声或X线引导下进行模拟穿刺。虽然该方法较非生物模拟器而言可方便学员体会穿刺
的手感,但在实际穿刺中,人的肾脏是随呼吸移动的,并且具体的解剖结构较猪或各种人模拟肾有一定的差异。这就使得学员在实际人体肾盏
穿刺时还是信心不足,不易把握穿刺的角度和深度。
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