术前泌尿系CT造影预定位结合超声实时引导在俯卧位经皮肾取石术中的应用

CT urography planning in combination with real time ultrasound localization for prone position of percutaneous nephrolithotomy

目的比较术前CTU预定位结合术中超声实时引导穿刺与单纯术中超声实时定位穿刺在俯卧位经皮肾镜取石术(PCNL)术中的安全性和有效性。方法中山大学附属第三医院自2011年6月至2014年3月118例复杂性肾结石行PCNL治疗的患者纳入本回顾性研究,其中实验组58例:采用术前CTU预定位结合术中超声实时修正定位穿刺;对照组60例:采用单纯术中超声实时定位穿刺。比较两组患者的一般临床资料,术中评价指标和术后并发症情况。结果所有手术均取得成功,无中转开放病例。实验组穿刺成功建立通道时间和手术总时间均较对照组短,差异具有统计学意义(t=7.598,7.614,P<0.05);实验组术中穿刺通道数目、因大出血需提前中止手术操作病例和二期手术取残石病例均较对照组少。两组患者均无血气胸、腹腔脏器损伤等严重并发症发生。结论 CTU预定位结合术中超声实时定位在PCNL术中安全有效。

Objective To compare the efficacy and safety ofCT urography planning in combination with real time ultrasound and only real time ultrasound localization in prone position of percutaneous nephrolithotomy.Methods A retrospective record review was conducted of 118 patients undergoing percutaneous nephrolithotomy,randomly categorized by the method of achieving renal access in the Third Affiliated Hospital from June 2011 to March 2014.Study group was practicing CT pyelography planning in combination with real time ultrasound,and control group practicing only real time ultrasound localization.Patient demographics,baseline characteristics,and operative and postoperative outcomes were compared between groups.Results All operations were successful with no case transferred to open surgery.No significant difference was observed between two groups in age,number of stones,cumulative stone diameter and renal dilated diameter （P〉0.05）.Patients undergoing CT pyelography planning in combination with real time ultrasound had shorter renal access time and total operative time （t=7.598,7.614,P〈0.05）.Procedure aborted due to bleeding and secondary procedure for stone management were more common in the control group than in the study group.No seriously complications were recorded.Conclusion CT pyelography planning in combination with real time ultrasound localization is safe and effective in prone position of percutaneous nephrolithotomy.