螺旋CT扫描在经皮肾镜碎石术围手术期的应用

目的：探讨在经皮肾镜碎石术围手术期中运用螺旋CT扫描及三维重建技术的临床价值。方法：对68例复杂性肾结石患者运用螺旋CT扫描及三维重建技术进行术前模拟定位，制定最佳的穿刺通道，术中根据CT结果搜寻结石，术后即刻、1、3、5天行CT扫描。结果：本组68例复杂性肾结石中建立手术通道75条：从穿刺到建立第一条手术通道的时间为5～10min，通道位置完全符合手术前设计72条；手术时间50～110min；38例结石完全取尽，结石完全清除率55．9％，残留结石碎片者（≤4mm）22例，残留小结石（〉4mm）8例；术中发生集合系统穿孔5例。胸腔积液者30例，占44．1％；全部患者皆有肾周积液，多者延及盆腔，平均约105．8ml，此后逐渐吸收；1例集合系统大量积血，术后全部肾脏肾实质皆较术前增厚，但此后逐渐恢复术前状态。结论：螺旋CT扫描能为经皮肾镜碎石术术前提供精确的穿刺径路，术中为寻找结石提供方向，术后能精确发现残存结石的大小、位置及有无出血、灌注液的逆流和外渗，螺旋CT扫描是经皮肾镜碎石术术前、术后较理想的影像学检查。

Assessment the Value of Spiral CT Scan in Percutaneous Nephrolithotomy for Complicated Renal Calculi

Objective：To investigate the value of spiral CT scan in minimally invasive percutaneous nephrolithotomy（MPCNL） for complex renal calculi. Methods：Sixty eight patients with complex renal calculi were collected in order to choose an optimal percutaneous approach into the pelvicaliceal system（PCS） prior to MPCNL, all consecutive patients received CT scan, reformatted CT was performed and data was analysed. We looked for calculi in the PCS by the result of CT scan. The patients received CT scan after the operation instantly,and then the first, third, fifth day, and the data were analysed. Results：Sixty eight patients with complex renal calculi were established seventy five percutaneous approach into the PCS, and the approaches were consisted completely with the preoperative project were seventy two. The time for establishing the approaches were 5-10 min, and the operative time were 50-110 min. Thirty eight patients were stone-free after operation,and twenty two were residual fragment（≤ 4 mm）,and eight were microlith（〉4 mm）, and five had pelvicaliceal system perforations, and much haematocele filled the PCS in one patient, and the patients with pleural effusion were twenty six, and the perirenal effusion were visited in all patients,and the mean perirenal effusion were 105.8ml, and then they were absorbed gradually. The thickness of the parenchyma were increased in all patients, but they were recovered gradually. Conclusions：The spiral CT scan and 3D reconstruction technique is helpful for the accurate puncturelocalization and direction in the percutaneous approach built in MPCNL of complicated renal calculi,and also help for looking for calculi and discovering the complication.