CT三维重建联合肾脏血管造影在经皮肾镜取石术治疗鹿角形肾结石中的应用研究

目的探讨螺旋CT三维重建联合肾脏血管造影(CTA)在经皮肾镜取石术(PCNL)治疗鹿角形肾结石的可行性及临床效果。方法本组34例鹿角形肾结石均行经皮肾镜取石术,观察手术时间、术中失血量、结石清除率。结果全部手术均取得成功,无严重并发症发生。手术耗时1.0～2.5h,平均1.5h。出血量30～300ml,平均112±30ml。总结石清除率91.4%。结论 CT三维重建联合肾脏CTA可提供肾盂肾盏集合系统、肾实质血管分布的清晰图像,并可发现结石和明确结石与肾盂肾盏集合系统的关系,可在术前发现肾动静脉瘘。与静脉尿路造影相比较,三维CT重建更有利于确定经皮肾穿刺的部位及穿刺通道选择。对于鹿角形肾结石,CT三维重建联合肾脏CTA应该成为经皮肾镜取石术前一种常规的影像学定位方法。

Three-dimensional CT reconstruction combined with kidney CTA for the planning of percutaneous nephrolithotomy in staghorn renal calculi

Objective To investigate the feasibility and clinical effect of spiral computed tomography with three-dimensional reconstruction combined with kidney CTA for preoperative planning of percutaneous nephrolithotomy in staghorn renal calculi.Methods Thirty four patients with staghorn renal calculi underwent percutaneous nephrolithotomy were enrolled in the study,to observe the operation time,intraoperative blood loss and the stone-free rate.Results All procedures were successful,no severe complications were recorded.The operative time was 1 to 2.5 hours(mean 1.5 hours).Intraoperative blood loss was 30 to 300 ml(mean 112±30 ml).Stone-free rate was 83% to 98%(mean 91.4%).Conclusions Three-dimensional CT reconstruction combined with kideney CTA provide a good map of the pelvicalyceal system(PCS) and the renal vascular distribution,can be found stones in all patients and accurately located their relation to the PCS,and more beneficial in determining percutaneous renal puncture site and puncture channel selection compared IVU.Three-dimensional CT reconstrucfion combined with kidney CTA should become a imaging method for planning PCNL in patients with staghorn calculi.