CT三维重建辅助经皮肾镜取石术穿刺定位

Choice of the optimal percutaneous approach in PCNL on the basis of three dimensional CT reconstruction

目的探讨螺旋CT三维重建在经皮肾镜取石(PCNL)穿刺定位中的应用价值。方法从2006年7月至2007年5月,对36例复杂性肾结石患者术前行多层CT尿路造影,于肾盂相期行造影剂增强扫描,数据被分析后进行三维重建,以确定最佳穿刺径路。结果CT尿路造影可提供肾盂肾盏集合系统的清晰图像,并可发现结石和明确结石与肾盂肾盏集合系统关系,与常规图像相比较,三维重建更有利于确定经皮肾穿刺的部位。全部患者行经皮肾镜取石术,结石清除率为89.5%,无严重并发症发生。结论CT三维重建可准确预测结石数量、大小及其所在部位,对经皮肾镜取石术穿刺定位具有指导意义。

Objective To investigate the role of spiral computed tomagraphy （CT） with three - dimensional （3D） reconstruction for preoperative planning of minimally invasive pereutaneous nephrolithotomy（PCNL） in patients with renal calculi. Methods Thirty - six patients with complicated renal calculi underwent multilayer CT urography from July 2006 to May 2007. A high - resolution contrast - enhanced scan was taken through the kidneys in the pyelographic phase. Data were analysed and three - dimensional reconstruction was performed in order to choose an optimal pereutaneous approach into the pelvicalyceal system （PCS） prior to minimally invasive MPCL. Results CT urography provided a clear view of the PCS, with stones detected in all patients and their relation with the PCS determined accurately. As compared with conventional imaging, 3D reconstructed images had the advantage of optimizing percutaneeus approach into the PSC. Minimally invasive PCNL was performed in all patients, stone - free rate was 89.5%, with no serious complications. Conclusion CT with 3D reconstruction can accurately determine the number, size and location of stones in pelvicalyceal system and help to choose the optimal percutaneous approach into the PCS before PCNL.