俯卧位CT三维成像在微创经皮肾镜取石手术中的临床应用

Clinical application of CT three-dimensional imaging in prone position to minimally-invasive percutaneous nephrolithotomy

目的探讨俯卧位螺旋CT三维重建影像在微创经皮肾镜取石术（mPCNL）中的应用价值。方法对43例复杂肾结石患者术前常规进行俯卧位螺旋CT扫描及图像三维重建，确定肾盂肾盏结构、结石位置、血管走行、穿刺路径等，在x线引导下行mPCNL。结果41例患者行mPCNL单通道手术34例，双通道手术7例；经肾上盏建立通道1例，经中盏36例，下盏4例；一期PCNL37例，二期取石4例，手术结石总取净率为97．6％。2例因重建后穿刺通道难以建立，行开放手术。无术中、术后大出血需输血者，无周围脏器损伤等严重并发症。手术时间70—200（125±37）min。结论俯卧位螺旋CT三维重建可术前评估能否行mPCNL，为mPCNL提供更加精确、直接的穿刺路径，减少术中出血，避免周围脏器损伤，提高结石清除率。

Objective To investigate the application value of CT three-dimensional imaging in prone position in minimallyinvasive percutaneous nephrolithotomy(mPCNL).Methods Forty three patients with complicated renal calculi received spiral computed tomography with three-dimensional reconstruction in prone position before the mPCNL in order to find out the pelvicaliceal constitution,the location of stones,the vessel distribution,and the optimal percutaneous puncture approach.The mPCNL was performed under the guidance of X-ray.Results Among the 43 patients,41 ones received the single tract mPCNL;7 ones received the double-tract mPCNL.The tracts were established via the upper renal calyx in one case,via the middle calyx in 36 ones,and via the lower calyx in 4 ones.Thirty seven cases received the PCNL in the first stage,and 4 received the lithotomy in the second stage.The complete clearance rate of stones was 97.6%.Two cases were turned into open nephrolithotomy because of the unsuccessful establishment of the tract.Severe complications did not occur during and after the operation,such as hemorrhea and abdominal organ injuries.The operative time was 70-200 minutes with the average of(125 ± 37) minutes.Conclusion The spiral computed tomography with three-dimensional reconstruction can evaluate whether mPCNL in prone position can be performed,and help to determine the more accurate and direct percutaneous puncture approach so that reduce the intraoperative bleeding,avoid the organ injuries,and increase the stone clearance rate.