螺旋CT三维重建联合B超定位在微创经皮肾镜取石术中的应用价值

Application Value of Spiral CT Three-Dimensional Reconstruction Combined with B-ultrasound Localization in Minimally Invasive Percutaneous Nephrolithotomy

目的探析螺旋CT三维重建联合B超定位在微创经皮肾镜取石术(PCNL)中的应用价值。方法选取2016年1月~2019年1月于我院就诊的84例泌尿系结石患者,其中28例患者加以螺旋CT三维重建设计经皮肾穿刺通道进行PCNL治疗,纳入CT组,28例患者加以B超定位进行PCNL治疗,纳入B超组,28例患者加以螺旋CT三维重建联合B超定位进行PCNL治疗,纳入联合组,比较三种方法建立工作通道成功率与结石清除率、手术指标与并发症情况以及应用价值。结果所有患者均无中转开放手术,三组经CT三维重建、B超以及CT三维重建联合B超建立经皮肾穿刺单通道,手术顺利完成;联合组一次性建立通道成功率、Ⅰ期结石清除率显著高于CT组、B超组,差异比较有统计学意义(P<0.05),三组Ⅱ期结石清除率无显著性差异(P>0.05);联合组穿刺时间显著短于CT组、B超组,血红蛋白下降量显著少于CT组、B超组,差异有统计学意义(P<0.05);三组手术并发症发生率比较,差异无统计学意义(P>0.05);B超在PCNL中Ⅰ期结石清除率的受试者工作特征曲线下面积(AUC)为0.826(95%CI:0.676-0.976),螺旋CT三维重建在PCNL中Ⅰ期结石清除率的AUC为0.739(95%CI:0.553-0.924),螺旋CT三维重建联合B超在PCNL中Ⅰ期结石清除率的AUC为1.000(95%CI:1.000-1.000),差异有统计学意义(P<0.05)。结论螺旋CT三维重建联合B超定位可明显提高PCNL手术建立工作通道成功率与Ⅰ期结石清除率,缩短穿刺时间,稳定血红蛋白水平,并发症发生率较低,应用价值更高。

Objective To explore and analyze the application value of spiral CT threedimensional reconstruction combined with B-ultrasound localization in minimally invasive percutaneous nephrolithotomy(PCNL).Methods 84 patients with urinary calculi who were treated in our hospital from January 2016 to January 2019 were selected.Among them,28 patients underwent PCNL treatment with percutaneous renal puncture channel by spiral CT three-dimensional reconstruction,and were included in CT group.And 28 patients was additionally given B-ultrasound localization for PCNL treatment,and included in B-ultrasound group,and 28 patients underwent spiral CT three-dimensional reconstruction combined with B-ultrasound localization for PCNL treatment,and were included in combined group.The success rate of working channel establishment and stone clearance rate,surgical indexes,complications and application value were compared among the three methods.Results All patients were without conversions to open surgery,and operations in the three groups were completed successfully through establishing percutaneous renal puncture single channel by CT threedimensional reconstruction,B-ultrasound and CT three-dimensional reconstruction combined with B-ultrasound.The success rate of one-time channel establishment and stage I stone clearance rate in combined group were significantly higher than those in CT group and B-ultrasound group(P<0.05),and there was no significant difference in the stage II stone clearance rate among the three groups(P>0.05).The puncture time in combined group was significantly shorter than that in CT group and B-ultrasound group,and the decrease of hemoglobin was significantly less than that in CT group and B-ultrasound group(P<0.05),and there was no significant difference in the incidence rate of complications among the three groups(P>0.05).The area under receiver operating characteristic curve(AUC)of stage I stone clearance in PCNL was 0.826(95%CI:0.676-0.976)by B-ultrasound,and the AUC of stage I stone clearance in PCNL was 0.739(95%CI:0.553-0.924)by spiral CT three-dimensional reconstruction,and the AUC of stage I stone clearance in PCNL was 1.000(95%CI:1.000-1.000)by spiral CT three-dimensional reconstruction combined with B-ultrasound(P<0.05).Conclusion Spiral CT three-dimensional reconstruction combined with B-ultrasound localization can significantly improve the success rate of working channel establishment and stage I stone clearance rate,shorten the puncture time,and stabilize hemoglobin level,and it has lower incidence rate of complications and higher application value.