CT尿路造影对复杂性肾结石行PCNL的术前应用

The preoperative evaluation of CT urography in PCNL treatment for complex renal calculi

目的:探讨CT尿路造影技术在复杂性肾结石PCNL术前评价的应用价值。方法:将复杂性肾结石患者60例分为实验组(30例,术前行64排螺旋CT尿路造影检查,进行图像重组,根据结石空间分布关系设计并建立PCNL通道进行腔内碎石取石术)和对照组(30例。采用同样方法进行治疗而术前只进行B超、IVP等常规检查,未行CT尿路造影检查)。结果:60例手术均获成功。实验组手术时间(82±32)min,术中出血量(88±42)mL,结石残留率为6.7%;对照组手术时间(142±40)min,术中出血量(101±51)mL,结石残留率为19.5%;两组比较,术中出血量两组无明显差异(P>0.05),实验组的手术时间以及结石残留率明显低于对照组(P<0.05)。结论:CT尿路造影能够清晰显示复杂性肾结石与肾动脉等重要周围结构的三维空间结构,有助于PCNL通道设计,提高了复杂性肾结石PCNL结石清除率和手术安全性。

Objective： To ecaluate the CTU for preoperative planning of percutaneous nephrolithotomy （PCNL） in patients with complex renal calculi. Methods： Collected 60 cases of complex renal calculi. Test group 30cases,preoperative 64-slice spiral CT urography examination, design the PCNL channel according to the spatial distribution of the calculi, and build cavity lithotripsy. The control group 30cases,using the same method of treatment （PCNL）, preoperative only ultrasound, IVP and other routine examination, without a CT urography examination. Results： All procedures were successful. The operative time of the test group was （82±32） min, the intra-operative blood loss was （88± 42） mL, and the rate of remaining calculi was 6.7%. However, the operative time of the control group was （142±40） min, the intra-operative blood loss was （101±51）,and the rate of remaining calculi was 19.5%. The intra-operative blood loss had no significant differences between the two groups（P〉0.05）, but the operative time and the rate of remaining calculi of the test group were significantly lower than that of the control group（P〈0.05）. Conclusions： CT urography can show the three-dimensional detail of renal calculi and renal arteries and other important structures. It is helpful in designing the PCNL accesses, and can improve complex renal calculi clearance rate and surgical safety.