预置双穿刺径路技术在经皮肾镜取石术治疗鹿角形肾结石中的应用

Percutaneous nephrolithotomy with two preset puncture paths for the treatment of renal staghorn calculi

目的:评价预置双穿刺径路技术在经皮肾镜取石术(PCNL)治疗鹿角形肾结石中的应用价值。方法:选择72例单侧鹿角形肾结石患者,采用64排螺旋CT平扫并进行结石三维重建,初步判断至少需要建立双通道,根据重建结果设定两个穿刺目标肾盏。患者均接受B超引导下主通道F22PCNL,必要时行F16MPCNL,记录手术时间、穿刺通道位置及数目、输血例数以及并发症。术后采用CT扫描判断有无结石残留。结果:术中实际穿刺肾盏与术前根据CT三维重建结果设计的目标肾盏完全一致,建立多通道数目与术前预测符合率为79.2%(57/72);一期手术结石取净率为70.8%(51/72),二期或多期结石取净率为81.9%(59/72)。结论:螺旋CT三维重建技术可形象直观地显示结石的立体结构,指导术前穿刺通道的选择、术中结石寻找,预置双穿刺径路技术可降低手术难度,提高结石清除率。

Objective：To evaluate the value of two preset puncture paths in percutaneous nephrolithotomy （PC NL） for renal staghorn calculi. Method： Seventy-two patients with unilateral staghorn calculi underwent 64 slice spiral CT scan and three-dimensimml reconstruction was taken for them before PCNL. We thought that two preset puncture paths were necessary to remove all the stones. ＇Two target calyces were preset according to the CT images. Then all patients underwent ultrasound-guided F22 tract PCNL, and F,6-tract MPCNL was used when necessary. CT scan was taken to explore residual calculi after operation. The operation time, tract placement, tract number, transfusion rale, stone clearance rate, complication were recorded. Resuit：Intraoperative punctured caly- ces were in accordance with preoperative preset target calyces. Fifty-seven calculi were cleared by multiple accesses, and the total stone-free rate was 70.8% （51/72） at one stage operation and 81.9%（59/72） at second-stage operation. Conclusion： The 3D reconstruction of spiral CT for staghorn calculi could provide three-dimensional shape and spatial structure of staghorn calculi intuitively, which was benefit for presetting the target calyces for patients with staghorn calculi and guiding for searching stone fragments in operation. The skills of two preset puncture paths could improve the stone clearance rate and reduce the operation difficulty.