自制格栅定位器与多排螺旋CT三维重建视频引导在经皮肾穿刺微造瘘术中的应用

目的 探讨自制格栅定位器与多排螺旋CT三维重建视频引导动态定位在经皮肾穿刺微造瘘(minimally invasive percutaneous nephrostomy,MPCN)术中的临床应用价值.方法 2008年9月～2012年6月,对58例急性肾功能衰竭、肾脏复杂结石、肾积水患者,局麻下采用自制格栅(grille)定位器辅助16排螺旋CT三维重建视频动态定位,行精确定位经皮肾穿刺微造瘘,行微创经皮肾镜碎石取石术(MPCNL) 30例,仅行MPCN 28例(其中8例双侧).结果 58例均一次成功完成MPCN,术中出血≤5 ml,无周围组织器官损伤.结论 自制格栅定位器辅助16排螺旋CT三维重建视频引导快速动态精确定位,具有MPCN成功率高、可视性强的优点,而且安全,操作简便,工作通道建立快捷,出血及并发症少,定位精确,值得推广应用.

Clinical Significance of 16 Detector-slice Spiral CT Reconstruction of Three Dimensional Video Positioning Assisted by Homemade Grille Positioner in Minimally Invasive Percutaneous Nephrostomy

Objective To investigate the clinical application of 16 detector-slice spiral CT reconstruction of three dimensional video positioning assisted by homemade grille positioner in minimally invasive percutaneous nephrostomy （ MPCN）. Methods From September 2008 to June 2012, 58 cases suffering from acute renal failure, complicated renal calculi and hydronephrosis underwent MPCN after 16 detector-slice spiral CT reconstruction of three dimensional video positioning assisted by homemade grille positioner. 30 cases received minimally invasive percutaneous nephrolithotomy （MPCNL） and 28 cases just received MPCN （including 8 bilateral cases）. Results All the 58 cases went through MPCN successfully, with a blood loss of ≤ 5 ml. No tissue and organ injury occurred. Conclusions The 16 detector-slice spiral CT reconstruction of three dimensional video positioning assisted by homemade grille positioner in MPCNL is safe and simple. It has less blood loss and complications, and is worthy of wide clinical application.