CT尿路成像在微创经皮肾镜取石术中的应用

目的探讨CT尿路成像（computed tomography urography，CTU）在微创经皮肾镜取石术（Mini-percutaneous nephrolithotomy，MPCNL）中的应用。方法37例行CTU检查，采用俯卧位，确定肾穿刺方向及深度，建立经皮肾穿刺通道；对37例肾结石、输尿管上段结石患者行微创经皮肾镜取石术。结果37例CTU检查清楚显示了肾结石在肾盂肾盏系统中的准确位置、肾盂形态、肾盏颈部结构及中后组肾盏结构，提供最优的穿刺路径。其中7例行B超、KUB、IVP等检查未发现结石，而CTU检查上均证实有输尿管上段结石，CTU结石诊断率为100％。37例患者均穿刺成功，成功率为100％，输尿管上段结石的取净率为100％，结石总取净率为91．6％。无输血病例、无腹腔脏器及胸膜损伤病例发生。结论CTU能提高结石检出率，能够提供精确的穿刺径路。减少穿刺损伤周围脏器的风险，减少手术出血。不增加X线的放射剂量。CTU能提高穿刺成功率，提高结石清除率，减少或避免术后并发症。

Value of multidetector computed tomography urography in mini-percutaneous nephrolithotomy

Objective To study the value of multidetector computed tomography urography in percutaneous nephrolithotomy. Methods Thirty-seven cases underwent helical multidetector computed tomography urography,and the scan was taken with the patients prone to build up renal tract for minimally invasive percutaneous nephrolithotomy according to CTU; thirty-seven renal or ureteral calculus were performed with MPCNL. Results Thirty-seven CTUs detected stones in all patients and accurately located their relation to the pelvicalyceal system and provided a good map of the pelvicalyceal system and the middle calyx. 3D imaging provided an advantage over conventional imaging in optimizing nephrostomy placement. 7 cases could not be diagnosed from B ultrasonic graphy,KUB and IVU,while CTU confirmed they were ureteral calculi. All the cases were punctured successfully,stone-free rate of upper ureteral calculus was 100%,and the total stone-free rate reached 91.6%. Conclusion CTU provides the optimum site (s) of the percutaneous track (s),and decreases potential hazards in placing the track with no significant increase in patient radiation burden. MPCNL can be safe and effective,high stone-free rate and low complications with CTU.