CT三维重建辅助鹿角形肾结石经皮肾镜取石术中穿刺定位

Three-dimensional CT reconstruction for the planning of percutaneous nephrolithotomy in staghorn calculi

目的探讨螺旋CT三维重建技术辅助鹿角形肾结石经皮肾镜取石术中穿刺定位的可行性及临床效果。方法本组82例鹿角形肾结石均行经皮肾镜取石术,术前随机分为CT三维重建组(3DCT实验组)37例和静脉泌尿系造影组(IVU对照组)45例。观察手术时间、术中失血量、穿刺通道数目和结石清除率。结果全部手术均取得成功,无严重并发症发生。3DCT实验组手术时间98±27.3 min,术中失血量127.1±34.5 ml,穿刺通道数目1.3±0.2个,结石清除率92.8%;IVU对照组手术时间127.3±26.7 min,术中失血量131.2±36.5 ml,穿刺通道数目1.7±0.3个,结石清除率84.2%。两组的失血量差异无统计学意义(P>0.05),而实验组结石清除率高于对照组,手术时间和穿刺通道数目少于对照组(P<0.05)。结论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,与静脉泌尿系造影相比较,三维CT重建更有利于确定经皮肾穿刺的部位。因此,对于鹿角形肾结石,CT三维重建应该成为经皮肾镜取石术前一种常规的影像学定位方法。

Objective To investigate the feasibility and clinical effect of spiral computed tomography （CT） with three-dimensional （3D） reconstruction for preoperative planning of percutaneous nephrolithotomy in staghorn calculi. Methods From May 2005 to June 2009, 82 patients with staghorn calculi who under-went percutaneous nephrolithotomy were enrolled the study. Of 82 patients, 37 patients underwent three-dimensional reconstruction CT（3DCT）, 45 intravenous urography. Operative time, intraoperative blood loss, the number of percutaneous track and stone-free rate were recorded. Results All procedures were successful, no severe complications were recorded. The operative time in 3DCT group was 98±27.3 min, intra-operative blood loss was 127.1±34.5 ml, percutaneous track was 1.3±0.2 and stone-free rate was 92.8%;However, the operative time in IVU group was 127.3±26.7 min, intra-operative blood loss was 131.2±36.5 ml, percu-taneous track was 1.7±0.3, and stone-free rate was 84.2%. There were no significant difference in blood loss in the two group （P〉0.05）. however, the operative time, the stone-free rate and the number of percutaneous track in 3DCT group were significantly lower than that of IVU group （P〈0.05）. Conclusions Conclusions tomographic urography （CTU） provided a good map of the pelvicalyceal system （PCS）. CTU detected stones in all patients and accurately located their relation to the PCS. Computed tomography （CT） with three-dimensional （3D） reconstruction provided an advantage over intravenous urography in optimizing nephrostomy placement. 3D-CT should become a imaging method for planning PCNL in patients with staghom calculi.