摘要
目的:探讨CT三维重建辅助B超联合X线术中定位经皮肾镜取石术(PCNL)治疗肾鹿角形结石的临床应用价值。方法:回顾性分析2016年6月—2019年6月在我院实施PCNL治疗的21例完全性鹿角形结石患者资料,所有患者术前均行结石CT三维重建,术中联合B超和X线定位穿刺建立通道,均建立16F或18F通道鞘。结果:21例患者均成功实施手术治疗,一期完全清除结石18例,3例残留小盏内结石患者于1个月后二期软镜碎石顺利,21例患者术后3个月复查均无结石残留。21例患者建立通道数均不超过2个,其中单通道6例,双通道15例,手术时间70~130 min,平均(92.3±26.8)min,术后平均住院时间为5 d,无感染性休克以及大出血病例。结论:完全性鹿角形肾结石患者,术前CT结石三维成像,术中联合B超和X线定位穿刺建立通道,有助于以尽可能少的通道最大限度清除结石,利于提高结石清除率,是一种安全、高效的治疗方式,值得临床应用以及推荐。
Objective:To investigate the application value and clinical effect of CT three-dimensional reconstruction combined B-ultrasound and X-ray localized percutaneous nephrolithotomy in the treatment of renal staghorn stones.Methods:Twenty-one patients with staghorn calculi who underwent urinary CT scan and three-dimensional reconstruction were enrolled into PCNL group from June 2016 to June 2019.All of them underwent 16 F or 18 F channel in operation,and were treated by PCNL under intraoperative X-ray,B-ultrasound guiding.Results:Twenty-one cases were completed successfully without conversion to open surgery.One-stage surgery was done on 21,but three of them needed second-stage surgery because of residual calculi.The stone free rate was 18/21(85.71%)after one-stage surgery and 21/21(100%)after 3 months surgery.In 21 patients,the number of established channels was no more than 2,including 6 in single channel and 15 in double channels.Moreover,the average operation time was(92.3±26.8)min(range,70-130)min,and the postoperative average hospital stay was 5 days.No hematorrhea occurred.Conclusion:CT three-dimensional reconstruction combined X-ray and B-ultrasound guiding in PCNL for staghorn calculi is safe and effective for its high stone clearance and less bleeding.It is worth clinical application and recommendation.
作者
李权
谢建军
蔡国烽
刘运练
邓君鹏
阙宏亮
曹文舟
沈华
LIQuan;XIE Jianjun;CAI Guofeng;LIU Yunlian;DENG Junpeng;QUE Hongliang;CAO Wenzhou;SHEN Hua(Department of Urology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,215000,China;Department of Diagnostic Radiology,Suzhou Hospital Affiliated to Nanjing Medical University)
出处
《临床泌尿外科杂志》
CAS
2021年第1期41-45,共5页
Journal of Clinical Urology
基金
苏州市医学重点学科基金项目(No:Szxk201810)。
关键词
鹿角形肾结石
CT三维重建
B超引导
X线
经皮肾镜取石术
staghorn calculi
CT three-dimensional reconstruction
B ultrasound guiding
X-ray
percutaneous nephrolithotomy