螺旋CT三维成像联合超声在经皮肾镜取石术中的应用

目的 探讨螺旋CT三维成像联合超声在经皮肾镜取石术（PCNL）中的临床应用.方法 实验组69例复杂性上尿路结石患者术前常规行螺旋CT及超声检查,对CT图像行三维重建,结合超声检查确定肾盂肾盏结构、结石位置及最佳穿刺途径,在超声引导下经皮肾穿刺造瘘碎石取石术.选择同期44例复杂性上尿路结石相似患者作对照组,除未行螺旋CT扫描外其余处理相同.结果 实验组69例均经单一通道行PCNL获得成功,手术平均时间85 min,一期结石总清除率 95.7 %,平均术中出血量100 ml,平均住院9.5 d;对照组44例中有5例2次造瘘成功,手术时间平均130 min,一期结石总清除率86.4 %,平均术中出血量200 ml,平均住院l5 d.两组均未出现大出血、肾盂穿孔和邻近脏器损伤等严重并发症.结论 螺旋CT三维成像联合超声对PCNL治疗上尿路结石有重要的临床应用价值.

Value of three-dimensional CT reconstruction in ultrasound-guided percutaneous nephrolithotomy

Objective To investigate the clinical value of three-dimensional （3-D） spiral CT reconstruction in uhrasound-guided percutaneous nephrolithotomy （PCNL）. Methods One hundred and thirteen patients with planned ultrasound-guided PCNL for complicated renal calculi were enrolled in this study. Sixty-nine patients nnderwenl spiral CT with 3-D reconstruction to analyze the pelvicalyceal anatomy and location of stone, and to determine the optimal percutaneous punclure approach for ultrasound-guided PCNL. Spiral CT examination was not performed on the remaining 44 patienls as the conlrol group. Results PCNL was successful with one percutaneous puncture on all 69 patients who underwent CT. The mean duration of PCNL was 85 minutes and the mean hospitalization time was 9.5 days, The stone-free rate was 95.7 % with mean intra-operative blood loss of 100 mL. In the c, ontrol group of 44 patients without CT, PCNL was successful on 5 patients after two percutaneons punctures. The mean operation time was 130 minutes and the mean hospitalization time was 15 days. The stone-free rale was 86.4 % with mean intra-operative blood loss of 200 mL. Severe hemorrhage requiring nephrectomy, abdominal organ injury or pneumothorax did not occur in either group. Conclusion 3-D spiral CT reconstruction is valuable in uhrasound-gnided PCNL.