CT三维重建在鹿角形结石行经皮肾镜碎石术中的应用

The application of CT 3D reconstruction for percutaneous nephrolithotomy in treating staghorn Calculi

目的经皮肾镜碎石取石术(PCNL)在处理鹿角形结石遇到诸多难题,CT扫描后三维重建构建结石与肾脏的3D影像以及与周围组织的位置关系,辅助PCNL术中超声定位提高穿刺精度,降低穿刺难度,提高结石清除率。方法 CT重建组纳入25例诊断为鹿角形结石患者,术前均行泌尿系CT平扫+三维重建,通过3D立体旋转,设计最短穿刺距离、直达肾盂、操作角度最广、最方便的通道,行斜仰卧位联合截石体位16 F单通道PCNL术;CT组纳入30例,术前仅行泌尿系CT平扫,通过平面CT片预先设计通道,行同样术式做对照组;并讨论2例典型鹿角形结石案例。结果 CT重建组与CT组在术中出血量([108±24)ml vs(156±45)ml]、手术时间([109±20)min vs(121±23)min]、结石清除率(91.21%vs 85.73%)以及造瘘管留置时间([6.5±1.9)d vs(7.7±1.7)d]的比较中,两组差异具有统计学意义(P<0.05);而在住院时间([13.0±1.8)d vs(14.5±3.0)d]、术后输血(0 vs 6.67%)和行高选择性肾动脉栓塞术(0 vs 6.67%)的比较上,两组差异无统计学意义(P>0.05)。结论 CT三维重建技术构建个体化鹿角形结石和肾脏的3D影像,为PCNL术的通道建立提供更精准的定位,从而实现手术风险的"最低化",结石清除效果"最佳化"。

Objective A lot of problems have been encountered in percutaneous nephrolithotomy in treatment of staghom calculi, 3D CT reconstruction technique could construct the real staghom calculi and kidney 3D image, which help us in the operations to make sure the best percutaneous renal channel, and improve the success rate of puncture by B-ultrasound localization. Methods Twenty-five patients with staghorn calculi who underwent urinary CT scan and 3D reconstruction were enrolled into CT reconstruction group. Through 3D rotation display, we designed the shortest distance channel, which directed to renal pelvis, with the most widely and convenient operating angle. Thirty patients only underwent urinary CT scan, and designed the operating channel with multiplanar CT film, who were enrolled into CT group. All of them underwent 16 F channel PCNL procedures in lateral semisupine lithotomy position, treated by nephroscope Holmium laser lithotripsy. While we discussed 2 typical cases of staghom calculi cases. There were statistical significances in blood loss [（108±24） ml vs （156±45） ml], operative time [（109±20） min vs （121±23） min], stone-free rate （91.21% vs 85.73%）, blood transfusion （0 vs 6.67%）, and massive hemorrhage post-operative cured by selective embolism of renal artery（0 vs 6.67%） between the two groups. Besides, there were no differences in the nephrostomy tube remaining time [（6.5±1.9） d vs （7.7±1.7） d] and hospital stay duration [（13.0±1.8） d vs （14.5±3.0） d]. Conclusions 3D CT reconstruction technique could construct the real staghorn calculi and kidney 3D image, which provided a more accurate percutaneous renal channel, it＇s safe and effective for PCNL.