SonixGPS影像穿刺定位系统在经皮肾镜取石术中应用的早期经验

Initial clinical experience of real-time ultrasound-guided percutaneous nephrolithotomy using the SonixGPS guidance positioning system

目的探讨SonixGPS影像穿刺定位系统在PCNL中应用的可行性及安全性。方法选取2012年5月上尿路结石患者15例，男8例，女7例。年龄33～72岁，平均43岁。患者术前均行KUB、彩色多普勒超声、CT和（或）IVU等检查。其中11例伴有不同程度的肾积水；合并尿路感染4例，术前给予积极抗炎治疗；孤立肾2例。。肾多发性结石7例，鹿角形结石3例，输尿管上段结石3例，肾结石合并输尿管上段结石2例。手术均采用全麻，取俯卧位，在SonixGPS影像穿刺定位系统的引导下，采用系统自带的16G穿刺针穿刺目标肾盏并扩张建立24F标准皮肾通道，置入肾镜后应用EMS第四代气压弹道联合超声碎石清石系统进行碎石并吸出体外。结果本组15例均一次穿刺成功并行一期碎石，手术时间30～115min，平均45min，经皮肾穿刺时间2～10min，平均4min。术中术后未出现大出血、肠道损伤、气胸等并发症。术后复查KUB，一期清石率为93％（14／15），1例有残余结石患者行ESWL治疗效果良好。结论SonixGPS影像穿刺定位系统在PCNL穿刺前可预判和设计穿刺路径及角度，穿刺中可精准地看到穿刺针在组织中的穿刺轨迹，实时记录针尖位置，及时调整穿刺针的角度与深度，缩短了经皮肾穿刺技术的学习曲线。

Objective To evaluate the feasibility and safety of SonixGPS guidance positioning sys- tem in PCNL. Methods In May 2012, a total of 15 patients with upper urinary tract calculi underwent PCNL by combining pneumatic and ultrasonic power （fourth generations of EMS） with the navigation of So- nixGPS guidance positioning system. A 16 G proprietary needle was inserted into the fornix of targeted calyx under the navigation of SonixGPS, needle-beam alignment and correct trajectory were maintained by observ- ing the indicator on the screen of SonixTouch ultrasound system. Preoperative imaging, including plain ab- dominal film of kidney, ureter, and bladder （KUB） , ultrasonography, computed tomography with or without intravenous urography. Eleven patients had different degree of hydronephrosis. Four patients had urinary in- fection and received antibiotic treatment before operation. Of the 15 patients, 7 had multiple calculi, 3 had staghorn calculi, 3 had upper ureteral calculi, and 2 had renal and ureteral calculi. Results The percu- taneous renal access was successfully established in 15 patients and followed with phase I lithotripsy. The mean operative time was 45 minutes, and the mean time of making a successful percutaneous access to the renal collecting system from an appropriate calyx was 4 minutes. Postoperative KUB demonstrated stone-free after primary procedure in 14 patients （93%）, and 1 patient need extracorporeal shock wave lithotripsy. No severe complication was detected in all 15 patients. Conclusions Real-time ultrasound-guided PCNL u-sing the SonixGPS goidance positioning system appears to be safe and efficacious. SonixGPS helps predict and clearly ohserve the needle＇s trajectory during invasive procedures. It helps improve skills in performing pereutaneous access and reduces the learning curve for PCNL. The major limitation of this study was that it was a case controlled study and not a randomized double-blind study. These results should be proved by fur- ther large-scale and multi-center clinical study.