螺旋CT辅助定位联合C型臂行微创经皮肾镜取石术

Combined Application of Assistant Localization by Spiral CT Scan and C-Arm in Minimally Invasive Percutaneous Nephrolithotomy

目的:探讨螺旋CT辅助定位联合C型臂在微创经皮肾镜取石术中的应用价值。方法:对15例输尿管上段结石、43例肾结石共58例63侧患者(CT组)在行经皮肾镜取石术前先行俯卧位螺旋CT扫描,确定穿刺点、穿刺角度和深度,术中据CT测量结果行盲穿,穿刺成功后及碎石毕再行C型臂检查以明确穿刺针及导丝进入肾脏收集系统位置、结石有无残留及部位,并与同期8例输尿管上段结石、23例肾结石共31例33侧(C臂组)直接在C型臂下行微创经皮肾镜取石术者进行比较。结果:CT组58例63侧平均穿刺1.22次,C型臂平均使用2.22次,均明显低于C臂组31例33侧的1.79次和4.52次(t=3.538,P=0.001和t=6.614,P=0.001);但CT组残石率为22.22%(14/63),与C臂组残石率30.30%(10/33)比较,差异无统计学意义(x^2=0.754,P=0.385)。结论:螺旋CT辅助定位联合C型臂行微创经皮肾镜取石术能有效提高经皮肾穿刺成功率并减少C型臂的应用,降低X线的辐射量,尤其适用于复杂肾结石的微创治疗及该项业务的推广应用。

Objective：To investigate the value of assistant localization by spiral CT scan and C-arm in minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods： 63 sides of 58 cases （CT group） including 15 cases of upper ureter stone and 43 cases oI renal calculi, which were performed prone position spiral CT scan before MPC- NL to localized the puncture spot, to measured the puncture distance and angle. During the surgery, performed blindly puncture according to CT measurement results. The C arm was used routinely after the puncture succeed and gravel finished, in order to clear the location of needle and guide wire into the renal collection system, whether with residual calculi and its location. 33 sides of 31 cases （C-arm group） including 8 cases of upper ureter stone and 23 cases of renal calculi were studied as a contrast group, which survived the puncture under the C-arm localization directly. Results：63 channels of 58 cases in the CT-group were built up with an average times of 1.22 puncture and an average times of 2.22 C arm use with a residue stone rate of 22.22% （14/63）, and in the C-arm group, the average puncture times, the C arm X ray use times and the residue stone rate were 1.79 , 4.52 and 30.30% （10/33） correspondingly for 33 channels in 31 cases. The statistical difference was significant in average puncture time and C-arm use between the two groups（t=3. 538,P=0. 001 and t=6. 614,P〈0. 001）, but no statistical significance in residue stone rate（ X^2 = 0. 754, P〈0. 385）. Conclusions：The combined application of assistant localization by spiral CT scan and C-arm in MPCNL can improve the succeed of percutaneous nephro-puncture and reduce the C-arm use and X-ray radiation effectively, especially in complicated renal calculi minimally invasive treatment and popularized use of the technique.