CT联合IVU预定位超声实时修正定位在经皮肾镜通道建立中的应用

Application of CT combined with intravenous urography pre-positioning corrected by real-time ultrasound positioning in establishment of percutaneous nephroscopic channel

目的探讨经皮肾镜碎石取石术(PCNL)初学者采用CT联合静脉/排泄性尿路造影(IVU)预定位超声术中实时修正定位在经皮肾镜通道建立中的应用价值。方法选取2016年1月至2016年11月我科住院的肾结石或输尿管上段结石拟行PCNL术的成人患者共128例,分为预定位组和常规组。预定位组患者术前预设穿刺路径,对照组采用常规术中实时定位。术前预定位组68例患者,术前根据CT和IVU设计穿刺路径、预定穿刺点。术中超声监视下对预定穿刺点进行修正,建立工作通道。常规组60例患者术前不进行预定位,术中实时超声定位。比较两组患者的皮肾通道建立时间、手术时间、血红蛋白损失情况,一次结石清除率等及其他并发症发生率,并进行统计分析。结果两组患者术前性别比例、年龄、结石大小、结石表面积和体质量指数比较差异无统计学意义。术后一次结石清除率、血红蛋白丢失和介入治疗比较差异无统计学意义。术前预定位组通道建立时间明显少于对照组(P<0.05)。常规手术组术后介入治疗止血1例。预定位组手术时间较常规组少,但差异无统计学意义。结论采用CT联合IVU预定位超声术中实时修正定位在经皮肾镜通道建立中能够更好选择最佳穿刺路径,提高穿刺准确性,缩短通道建立时间,值得在基层医院和PCNL初学者中推广应用。

Objective To explore the application value of CT combined with intravenous urography （IVU） pre-positioning corrected real-time ultrasound positioning in the establishment of percutaneous nephroscopic channel for percutaneous nephrolithotomy （PCNL） beginners. Methods A total of 128 adult patients with kidney or upper ureteral calculi treated in our department from January to November, 2016 were enrolled and divided into the preoperative positioning group and control group. In the preoperative positioning group （n=68）, the puncture path and puncture point were designed before surgery according to CT and IVU. Intraoperatively, the pre-determined puncture point was corrected under ultrasound monitoring to establish a working channel. In the control group （n=60）, intraoperative real-time ultrasound positioning was carried out. The establishment time of percutaneous nephroscopic channel, operation time, hemoglobin loss, primary calculus removal rate and incidence of other complications were statistically compared between the two groups. Results Before surgery, no statistical signifcance was noted in sex ratio, age, calculus size, calculus surface area and body mass index between the two groups.Postoperatively, the primary calculus removal rate, hemoglobin loss and interventional therapy did not signifcantly differ between the two groups. The channel establishment time in the preoperative positioning group was significantly shorter than that in control group （P﹤0.05）. In control group, 1 case received hemostasis with interventional therapy after operation. The operation time in the preoperative positioning group was slightly shorter than that in control group without statistical signifcance. Conclusion CT combined with IVU pre-positioning corrected by reat-time ultrasound positioning can select the optimal puncture path, improve the puncture accuracy and shorten the channel establishment time, which is worthy of application in primary hospitals.