320排CT三维重建联合血管造影对经皮肾镜碎石术手术转归的影响

目的评价320排CT三维重建联合血管造影(CTA)在经皮肾镜碎石术中的应用价值。方法回顾性分析2010年3月至2012年5月90例复杂肾结石,其中50例患者术前仅行静脉尿路造影(IVU)检查(对照组);另外40例患者术前行IVU外再加做肾脏320排三维重建及CTA(320CTA组)。术后比较2组患者的结石清除率及术后并发症等指标。结果所有患者全部穿刺成功,建立通道满意,一期清石率对照组为76%(38/50),320CTA组为82.5%(33/40)。术后对照组血色素下降为(11.9±9.7)g/L,320CTA组血色素下降(6.4±6.6)g/L,两者有统计学差异(P0.05)。两组患者均无胸膜及内脏器官损伤。结论对于复杂肾结石,320排三维重建及CTA可以明确结石、肾盂肾盏、肾分支血管三者关系,以利于设计最佳通道,避开较大血管,从而提高清石率及降低大出血风险,在经皮肾镜碎石术前评估中有其独特的价值。

Effect of 320-row three-dimensional CT reconstruction combined with kidney CTA in PCNL

Objective To evaluate the clinical significance of 320-row three-dimensional CT reconstruction combined with kidney CT angiography （CTA） in percutaneous nephrolithotomy （PCNL）. Methods Data of 90 patients with complicat- ed renal calculi treated during March 2010 to May 2012 were retrospectively analyzed. 50 patients examined only with intrave- nous urography （IVU） were taken as the control group, and the other 40 patients examined with IVU and 320-row three-di- mensional CT reconstruction combined with CTA served as the 320CTA group. Several postoperative indicators were compared between the two groups. Results All patients were punctured successful and the channel was established satisfactorily. The stone clearance rate of the control group and 320CTA group was 76 %（38/50） and 82.5 % （33/40） respectively. Postoperative hemoglobin of the control group decreased to （11.9±9.7）g/L, and that of the 320CTA group decreased to （6.4 ± 6.6）g/L, with a significant difference between the two groups. All patients had no pleural and visceral organ damage. Conclusions 320-row three-dimensional CT reconstruction combined with kidney CTA is able to accurately demonstrate the relation between stone location, renal pelvis and calices, and renal arterial branches, providing vital information to design the best surgical chan- nel to avoid larger vessels, thereby enhancing the stone clearance rate and reducing the risk of bleeding.