螺旋CT联合B超引导微创经皮肾镜碎石取石术治疗上尿路结石临床分析

目的探讨螺旋CT联合B超引导微创经皮肾镜碎石取石术治疗上尿路结石的安全性和有效性。方法对834例肾结石和复杂性输尿管上段结石患者,术前采用肾脏32层螺旋CT扫描和三维重建,根据重建CT三维成像以设计经皮肾穿刺通道。术中采用超声引导经皮肾穿刺,建立经皮肾通道碎石取石术。总结分析手术方法、手术时间、结石清除率和并发症等情况。结果 834例手术均一次性穿刺成功,其中单通道取石810例,双通道取石24例,术中穿刺通道与术前预设通道符合798例;一期碎石取石803例,一期造瘘二期碎石31例;手术时间54~182min;术中平均出血约70mL;肾造瘘管留置时间平均6.5d;术后平均住院日9d;无一例出现大出血、肾盂穿孔和邻近脏器损伤等严重并发症;834例患者中一期结石取净率达84.17%(702/834)。结论术前肾脏螺旋CT扫描加三维成像以设计经皮肾穿刺通道,结合术中实时超声定位引导,可以提高经皮肾镜手术成功率,增加手术安全性,降低手术并发症,提高结石清除率,在上尿路结石的治疗中具有很好的应用价值。

Clinical Analysis of Upper Urinary Tract Calculi Treated by Spiral CT Combined With B-Ultrasound Guided Minimally Invasive Percutaneous Nephrolithotripsy

Objective To explore the safety and effectiveness of spiral CT combined with B-ultrasound guided minimally invasive percutaneous nephrolithotomy for the treatment of upper urinary calculi. Methods In 834 cases of renal calculus and complicated upper ureteral calculi,32-slice spiral CT scanning and three-dimensional reconstruction were used before operation to design the percutaneous renal puncture channel.Results All 834 cases were successful in one-time puncture,including 810 cases of single-channel stone and 24 cases of double-channel stone removal.Among them,the intra-operative puncture channels were consistent with the pre-operative channel in the 798 cases.803 cases were treated with first stage lithotripsy and 31 cases were treated with fistulation before the lithotripsy.The operation time was 54-182 min,and the average bleeding was about 70 ml during the operation.The average retention time of renal fistula tube was 6. 5 days,and the average hospitalization time was 9 days after operation.There were no severe complications such as major bleeding,perforation of renal pelvis and damage to adjacent organs.In 834 cases,the rate of stone removal at the first stage was 84. 17%( 702/834). Conclusion The preoperative renal spiral CT scan plus three-dimensional imaging can improve the success rate of percutaneous nephroscope operation,and it increases the safety of operation,reduce the complications of operation and improve the stone clearance with intraoperative real-time ultrasound guidance which have a good application value in the treatment of upper urinary tract calculus.