螺旋CT扫描在微创经皮肾镜取石术中的应用

目的：探讨螺旋CT扫描在微创经皮肾镜取石术（MPCNL）中的应用价值.方法：对157例上尿路结石患者术前行俯卧位螺旋CT扫描,了解结石三维结构,确定穿刺目标肾盏及其穿刺方向及深度,以完成MPCNL的治疗.结果：157例患者术前螺旋CT扫描检查可清楚显示上尿路结石在上尿路的准确位置及结石间的位置关系、肾盂形态、肾盏颈部形态、中后组肾盏结构.所有患者均穿刺成功,其中一期手术取石143例,二期手术取石14例;单通道取石148例,双通道取石9例,结石总取净率为91.6%,1例术后出现迟发性出血,经保守治疗治愈.结论：螺旋CT扫描有助于设计合适的经皮肾通道,提供精确的穿刺方向及深度,提高穿刺成功率、结石清除率,减少或避免术后并发症.

Clinical Application of Spiral CT Scan in Mini-Percutaneious Nephrolithotomy

Objective：To investigate the value of spiral CT scan in mini--percutaneous nephrolitbotomy （MPCNL）. Methods： One hundred and fifty-seven patients with upper urinary calculi underwent a spiral CT scan in prostrate position so as to identify the three-dimensional structure of stones and determine the target calyces for puncture and the direction and depth of puncture. The MPCNL was then successfully performed. Results：The spiral CT scan performed on the 157 patients prior to the MPCNL accurately located the position of upper urinary calculi and their positional relations, and also clearly showed the pelvicalyceal system and the middle calyx, which were helpful in choosing the optimal percutaneous approach. All the patients were punctured successfully, among which 14a cases underwent one-stage MPCNL, 14 cases two-stage MPCNL, 148 cases single-channel MPCNL, and 9 cases bi-channel MPCNL. The total stone-free rate reached 91.6%. One case with delayed bleeding after operation was cured after expectant treatment. Conclusions：The spiral CT scan can provide accurate direction and depth of puncture, enhance the success rate of puncture, increase the stone free rate, and thereby decrease or avoid postoperative complications.