术中C型臂X光机检查在466例经皮肾镜取石术中的应用

The efficacy of C-arm to determine residual stones during percutaneous nephrolithotomy

目的探讨经皮肾镜取石术中C型臂X光机检查结石的必要性。方法从2011年10月至2013年12月期间,在466例上尿路阳性结石患者经皮肾镜取石术结束前,经皮肾镜认为结石已经干净,再用C型臂X光机检查,观察有无结石残余,以进一步取石或决定二期手术处理。将C型臂X光机检查前后的结石清除率进行统计学分析（McNemar检验）。结果 C型臂X光机透视发现,输尿管上段结石见有〉4mm结石碎片残留2例,肾盂结石4例,肾盏结石3例;再次经原通道或另再建立通道后入镜,除1例外,全部成功取出。鹿角形结石见有〉4mm结石残余24例,再次入镜,成功取出15例;多发肾结石见有〉4mm结石残余25例,再次入镜,成功取出19例。术后2～4d复查尿路平片,术中C型臂X光机确认有结石残余者,术后均证实结石残余,C型臂X光机认为结石已取净的患者中仍有5例残留。各种结石的清除率在C型臂X光机检查后均有提升,鹿角形肾结石（P〈0.001）、多发肾结石（P〈0.001）提升显著。结论经皮肾镜取石术结束前需用C型臂X光机确认结石是否残余,尤其是对于鹿角形肾结石和多发肾结石,可明显提高结石清除率。

Objective To evaluate the efficacy of C-arm in determining residual stones during percutaneous nephrolithotomy（PCNL）.Methods From Oct.2011 to Dec.2013,466 patients with upper urinary tract radiopaque stones were treated with PCNL,and were diagnosed as stone-free by percutaneous nephroscopy.Then C-arm was used to determine whether there were residual stones to determine the secondary procedure.The stone-free rate before and after C-arm check were analyzed with McNemar test.Results The C-arm found upper ureteral stones in 2 cases,renal pelvis stones in 〉4 cases,calyx stones in 3 cases,staghorn stones4 mm in 24 cases,and multiple renal stones in 25 cases.After a second PCNL,most residual stones were successfully removed.KUB radiography 2 days after operation found that cases diagnosed to have residual stones by C-arm did have residual stones,while 5 cases diagnosed as stone-free still had residual stones.By using C-arm technique,the stone-free rate of all kinds of calculi was increased,including that of staghorn calculi and multiple kidney calculi（both P〈0.001）.Conclusion It is necessary to confirm the residual stones by C-arm intra percutaneous nephrolithotomy,especially for staghorn calculi and multiple kidney stones,which can significantly improve the stone-free rate.