螺旋CT三维重建影像在标准通道经皮肾镜取石术中的临床应用

Clinical application of three-dimensional CT reconstruction in standard tract percutaneous nephrolithotomy

目的探讨螺旋CT三维重建影像在标准通道经皮肾镜取石术中的应用价值。方法对2008年1月～2009年3月26例复杂肾结石患者术前常规进行螺旋CT扫描及图像三维重建,确定肾盂肾盏结构、结石位置、最佳穿刺路径等,在B超引导下行标准通道经皮肾镜取石术。结果26例患者行PCNL28例侧,其中结石所在侧Br觟del型肾脏22例侧,Hodson型肾脏6例侧。合并肾积水15例(57.69%)。单通道手术23例,双通道手术3例。经肾上盏建立通道1例,经中盏23例、下盏5例。第12肋下穿刺16例次,第11肋间穿刺13例次。一期PCNL20例,结石总清除率75%,二期取石3例。中转开放手术2例。1例孤立肾肾结石合并重度肾积水者,结石寻找困难,因病情危重行经皮肾造瘘术。一期PCNL无术中、术后大出血需输血者,无胸膜、腹腔器官损伤等严重并发症。手术时间15～240min,平均(117±68)min。结论螺旋CT三维重建能够为B超引导下的PCNL提供更加精确的穿刺径路,有助于减少手术出血,避免穿刺损伤周围脏器,提高结石清除率。

[ Objective] To investigate the clinical value of spiral computed tomography with three-dimensional reconstruction in standard tract percutaneous nephrolithotomy （PCNL）. [ Methods ] Twenty-six patients with complicated renal calculi, which would be treated on by standard tract PCNL under the guide of B ultrasound, were performed spiral computed tomography with three-dimensional reconstruction for analysing the pelvicaliceal anatomy and the location of stone and determining the optimal percutaneous puncture approach from Jan. 2008 to Mar.2009. [Results] Among the 26 patients, 24 cases suffered from unilateral renal calculi, 2 cases bilateral. Kidneys with cal- culi tended to resemble Brrdel＇type in 22 units, Hodson＇type in 6 units. Fifteen patients （57.69%） had hydronephrosis. The calculi were removed through one passage in 23 cases, double passage in 3 cases. 23 cases were successfully established the standard tract PCNL by middle calyces under the guidance of B ultrasound and spiral computed to- mography, 1 case by uppercalyx, 5 eases by lower calyces. Phase I lithotripsy was performed in 20 cases. The de- layed stage Ⅱ lithotripsy was carried in 3 cases. The stone-free rate was 75% in one-session procedure. PCNL in 2 cases were changed into open nephrolithotomy. One case was performed percutaneous nephrostomy due to sevi- ous renal failure. Severe complications did not occur during operation, such as hemorrhage needing nephrectomy and abdominal organ ingury or pneumothorax. The mean operation time was （117±68） rain. [ Conclusions ] The spiral computed tomography with three-dimensional reconstruction combining B ultrasound in PCNL can help to determine the optimal pereutaneous puncture approach, and to reduce the risks of the operation and to increase the stone-free rate.