CT三维重建辅助经皮肾镜碎石术治疗复杂肾结石的应用价值

Application value of CT three dimensional reconstruction combined with PCNL in treat of complex renal calculi

目的探讨利用软件对平扫CT进行三维重建定位穿刺点、进针角度及深度在经皮肾镜取石术(PCNL)治疗复杂性肾结石手术中的可行性和应用价值。方法 271例复杂性肾结石患者随机分组,其中147例术前行CT三维重建(三维组),124例术前未行CT三维重建(对照组)。三维组术前通过CT三维重建,明确结石的大小、位置、分布、与集合系统关系等情况,确定穿刺的目标肾盏、穿刺位置、进针深度及角度。两组均在实时超声定位下行经皮肾镜碎石术,比较两组手术时间、穿刺成功率、血红蛋白损失量、结石清除率以及术后并发症。结果两组血红蛋白损失量差异无统计学意义(P>0.05);与对照组相比,三维组手术时间短,穿刺成功率高,结石清除率高(均P<0.05);两组均无严重并发症。结论 CT三维重建在术前为PCNL处理复杂性肾结石提供了准确的穿刺位置、进针深度及角度,再配合术中B超可明显提高穿刺成功率,缩短手术时间,提高结石清除率,具有一定的应用价值。

Objective To investigate the feasibility and applicable value of three-dimensional reconstruction based non-contrasted CT using software to locate the puncture points, the needle angle and depth in the treatment of complex renal stone by percutaneous nephrolithotomy（PCNL）. Methods 271 patients with complex renal stone were randomly enrolled into this study, among which 147 patients receiving three-dimensional reconstruction based non-contrasted CT pre-operationally were classified as three-dimensional group and the other 124 cases without three-dimensional reconstruction as control group. The attributes of renal stone （the size, position, distribution, the relation with the collecting system, etc）, the target calyces, puncture points and the needle angle ＆ depth were ascertained via the pre-operative three-dimensional reconstruction in the three- dimensional group. The patients in two groups underwent PCNL under the real-time ultrasound. The surgical time, the success rate of puncture, the loss of hemoglobin, the stone clearance rate and the post-operative com- plications in two groups were compared. Results There are no significant statistically difference in the loss of hemoglobin between two groups. There are shorter surgical time, the higher success rate of puncture and the higher stone clearance rate in the three-dimensional group compared with the control group （P 〈 0.05）.No severe complications had occurred in two groups. Conclusion CT three-dimensional reconstruction provides accurate puncture positions, the needle angles and depth in the treatment of PCNL preoperatively, which could improve the success rate of puncture and the stone clearance rate and shorten the surgical time combined with intraoperative ultrasound, has some practical value.