B超引导钢针十字投影在经皮肾镜穿刺定位中的应用体会

Ultrasound-guided steel needle cross projection in percutaneous nephroscopy localization

目的评价B超引导钢针十字投影在经皮肾镜穿刺定位临床治疗中的应用价值。方法选取该科2015年7月-2017年7月采用B超立体精准定位引导经皮肾镜取石术(PCNL)病例307例,结石分别有鹿角形结石、肾盏内多发性肾结石、体外冲击波碎石(ESWL)治疗失败、孤立肾结石、肾盂输尿管连接部(UPJ)梗阻合并结石、开放取石手术后复发和输尿管上段结石等。参照术前CT和腹部平片+静脉肾盂造影(KUB+IVP)确定穿刺角度及要穿刺的肾盏。然后,在B超立体精准定位下选择好第一标记线和第二标记线,两线交汇处为最终穿刺点,此点与第一标记点连线需与肾脏纵轴垂直。最后在最终穿刺点在B超立体探测引导下调整好探针角度进行目标肾盏穿刺。结果 307例患者中281例1或2次穿刺成功,21例3~5次穿刺成功,总的成功率98.4%(302/307),5例小切口分离至肾周在手指指导下穿刺成功。1例术后第2天出血严重(经选择性肾动脉栓塞止血)。结石取净率95.8%(294/307),13例残余结石,均≤0.5 cm。结论 B超立体精准定位应用于PCNL中安全有效,细化了定位方法,简便易行,值得推广。

Objective To evaluate the application value of ultrasound-guided steel needle cross projection in percutaneous nephroscopy localization for clinical treatment. Methods From July 2015 to July 2017, we selected 307 cases of percutaneous nephrolithotomy with ultrasonic stereoscopic precision positioning, stones are antipyroid stones, renal calculi multiple kidney stones, ESWL treatment failure, isolated kidney stones, renal pelvis and ureteral junction （UPJ） obstruction with stones, open stone surgery recurrence, upper ureteral stones and so on. Refer to preoperative CT and KUB＋IVP to determine the puncture angle and the puncture of the calyx. Then, in the ultrasonic stereo precise positioning to select the first mark line and the second mark line, two-line intersection for the final puncture point, this point with the first mark point connection with the vertical axis of the kidney.Finally, at the end of the puncture point in the ultrasonic stereo precise probe under the guidance of the probe to adjust the target angle of the calyx puncture. Results Of the 307 patients, 281 were 1 - 2 successful punctures, 21 were 3 - 5 times. The total success rate was 98.4% （302/307）. 5 cases of small incision were separated to the kidney weeks under the guidance of the fingers.1 case of bleeding after 2 days （by selective renal artery embolization to stop bleeding）.The net rate of calculi was 95.8% （294/307） and 13 residual stones were less than 0.5 cm. Conclusions The application of ultrasonic stereoscopic accurate positioning in percutaneous nephroscopy is safe and effective, and the localization method is refined and easy to be promoted.