基于CT+三维重建技术的不同穿刺路径对经皮肾穿刺肾上盏的安全性研究

Safety of percutaneous renal puncture of the upper calyx with different puncture pathways

目的探讨不同穿刺路径对12肋上缘经皮肾穿刺肾上盏通道安全性的影响。方法回顾性分析2020年2月至2021年6月惠州市第一人民医院106例行CT检查上尿路结石患者的CT检查结果,并利用三维重建技术,在肩胛线与腋后线区域,模拟经12肋上缘至肾上盏的穿刺线,分析不同穿刺路径对经皮肾穿刺肾上盏的安全性以及确定经12肋上缘经皮肾穿刺肾上盏的最佳穿刺路径。结果穿刺点接近肩胛线与竖脊肌外缘的穿刺路径中,肾上盏与体表距离、穿刺路径距胸膜反折的距离、穿刺线与肾上盏穹隆-盏颈轴线交角小于穿刺点接近肩胛线与腋后线中点、腋后线的穿刺路径,差异有统计学意义(P<0.05);三种穿刺路径中肾上盏与体表距离、穿刺路径距胸膜反折的距离、穿刺线与肾上盏穹隆-盏颈轴线交角比较,差异有统计学意义(P<0.05)。三维重建模拟穿刺路径中,所有斜向下虚拟穿刺通道中,无肝脏、脾脏和结肠重叠在穿刺线,未发现胸膜、肺下界、肝脏、脾脏及后位结肠器官损伤。结论接近肩胛线和竖脊肌外缘经12肋上穿刺入路上盏安全有效,可作为经皮肾镜取石术的理想穿刺路径。

Objective This study aimed to investigate the effects of various puncture pathways on the safety of percutaneous renal puncture of the upper calyceal channel at the upper edge of the 12 th rib.Methods The CT examination results of 106 patients with upper urinary tract calculi who underwent CT examination at The First People’s Hospital of Huizhou between February 2020 and June 2021 were retrospectively analyzed.Three-dimensional reconstruction was used to simulate the puncture line from the upper margin of the 12 th rib to the upper calyces in the scapular line and posterior axillary line area.The safety of different puncture pathways for percutaneous renal puncture was analyzed,and the optimal puncture routes for percutaneous renal puncture through the upper edge of the 12 th rib were determined.Results No damage was observed in the pleura,lower lung,liver,spleen and posterior colon in the virtual routes from the upper edge of the 12 th rib to the suprarenal calyx,with puncture points near the scapular line and the outer edge of the erector spinae muscle,the midpoint of the scapular line and the posterior axillary line,and the posterior axillary line.The fornix of the suprarenal calyx was found to be easily punctured with the puncture point near the scapular line and the outer edge of the erector spinae,which had the shortest puncture route and the smallest angle of intersection of the caliceal vault-caliceal neck axis.Conclusion The path from the upper edge of the 12 th rib to the suprarenal calyx,with the puncture point near the scapular line and the outer edge of the erector spinae muscle,is safe and effective,and is an ideal puncture path for PCNL.