瞬时X线定位联合术中逆行造影在经皮肾镜碎石术中的临床价值

Instantaneous X-ray positioning combined intraoperative retrograde urethrography in the clinical value of percutaneous nephrolithotomy

目的：探讨瞬时X线定位联合术中逆行造影在经皮肾镜碎石术（percutaneous nephrolithotomy,PCNL）中的安全性、实用性及其临床价值。方法：回顾性分析我院2014年1~12月采用瞬时C臂X线定位联合术中逆行造影引导下行PCNL治疗118例肾结石患者的临床资料,对患者首次目标肾盏穿刺成功率、通道建立时间、术中X线暴露次数、结石Ⅰ期清除率等进行分析。结果：118例患者有116例在瞬时X线定位联合术中逆行造影引导下准确建立理想的工作通道,成功率为98.3%,其中首次目标盏穿刺成功率为77.9%（92/118）,另外2例患者因肾积水较轻,建立通道失败,改为连续C臂X线定位,透视下成功建立通道;所有患者均建立F18~20通道,通道建立时间10~35min,术中X线暴露次数2~5次。平均手术时间74（72.26±20.26）min。结石一期清除率为85.59%（101/118）;术后行二期碎石术或EWSL治疗者占11.86%（14/118）。结论：采用瞬时X线定位联合术中逆行造影引导下PCNL治疗肾结石能明显提高首次目标盏穿刺成功率,缩短通道建立时间,提高结石Ⅰ期清除率高,同时减少患者及医生在手术中X线的暴露时间,值得临床推广使用。

Objective：To study the transient X-ray positioning combined intraoperative retrograde urethrography in percutaneous nephrolithotomy in safety,practicality and its clinical value.Method：A retrospective analysis in January 2014-December using instantaneous C arm X-ray positioning combined intraoperative retrograde urethrography suffer nephroscope lithotripsy treatment guided by the clinical data of 118 cases of patients with renal stones,for the first time for the patient target puncture success rate,channel set up time,stoneⅠ clearance etc are analyzed.Result：118patients with 116 cases in instantaneous X-ray guided by positioning combined with intraoperative retrograde urethrography accurate channel,establish ideal job success rate was 98.3%,among them the first time the target light puncture success rate was 77.9%（92/118）,the other 2patients with kidney seeper lighter,establish channel failure,instead of C arm X-ray locating in a row,perspective managed to establish a channel;All patients were established f-18s-20 channels,establishing time 10-35 min,intraoperative X-ray exposure times 2-5times.The average operation time of 74min（72.26±20.26）.Stone of a clearance rate was 85.59%（101/118）;Postoperative phase ii lithotripsy or EWSL treatment accounted for 11.86%（14/118）.Conclusions：Using instantaneous X-ray positioning combined with intraoperative retrograde imaging guided percutaneous nephroscope lithotripsy to treat kidney stones can obviously increase the target light puncture success rate,shorten the channel set up time for the first time,improve the stoneⅠ period clearance rate is high,at the same time reduce the patient and the doctor in the surgery of X-ray exposure time,worthy of clinical promotion use.