CT血管造影在后腹腔镜肾盂肾窦切开取石术中的应用

Application of CT angiography in retroperitoneal laparoscopic intrasinusal pyelolithotomy

目的探讨在后腹腔镜肾盂肾窦切开取石术中应用CT血管造影(CTA)对于规避各种血管相关并发症的价值。方法回顾性分析我科2015年2月至2017年3月157例行后腹腔镜肾盂肾窦切开取石术治疗的病例;比较入院行肾CTA检查后再实施后腹腔镜肾盂肾窦切开取石术治疗的患者(术前CTA组)和入院后直接实施后腹腔镜肾盂肾窦切开取石术的患者(常规手术组)手术中转率、术中出血量、手术时间、术中术后血管相关并发症、术后漏尿率、术后住院时间的情况。结果术前CTA组患者,其手术中转率、术中出血量、手术时间、术中术后血管相关并发症、术后漏尿率、术后住院时间均优于常规手术组,2组比较差异有统计学意义(P<0.05);术后1周复查超声肾积水均有不同程度恢复,2组比较差异无统计学意义(P>0.05);术后并发症、术后住院时间比较,术前CTA组优于常规手术组,差异有统计学意义(P<0.05)。结论行肾CTA检查后再实施后腹腔镜肾盂肾窦切开取石术治疗,可以明显减少术中血管相关并发症的发生、减少术中出血量、缩短手术及术后住院时间等,对于提高手术安全性及提高医疗资源应用效率具有较高的应用价值。

Objective To explore the application value of CT angiography（CTA） for avoiding various vascular complications in retroperitoneal laparoscopic intrasinusal pyelolithotomy. Methods A retrospective analysis was performed on 157 cases undergoing the retroper- itoneal laparoscopic intrasinusal pyelolithotomy in our department from February 2015 to March 2017 by comparing the operation conversion rate ,intraoperative blood loss, operation time, intraoperative and postoperative vascular complications, postoperative urine leakage rate and postoperative hospital stay between the two groups,i, e. the preoperative CTA group who underwent renal CTA examination and retroperitoneal laparoscopic intrasinusal pyelolithotomy successively after admission to hospital, and the conventional operation group who underwent the retroperitoneal laparoscopic intrasinusal pyelolithotomy directly after admission to hospital. Results The preoperative CTA group was superior to the conventional operation group in operation conversion rate, intraoperative blood loss, operation time, postoperative and postoperative vascular complications, postoperative urine leakage rate, and postoperative hospital stay;and the differences between the two groups were statistically significant（ P 〈 0.05 ）. One week after the operation, B ultrasound showed that hydronephrosis recovered to different degrees and the difference in re-examination results between the two groups were not statistically significant（ P 〉 0.05 ）. In terms of the postoperative complications and postoperative hospital stay, the preoperative CTA group was better than the conventional operation group, and the difference between the two groups was statistically significant （ P 〈 0.05 ）. Conclusion The renal CTA examination and retroperitoneal laparoscopic intrasinusal pyelolithotomy may be performed successively to significantly reduce the occurrence of intraoperative vascular complications, reduce intraoperatire blood loss and shorten the operation and postoperative hospital stay, and thus can improve the operation safety and application efficiency of medical resources.