CT三维重建辅助B超联合C型臂X光机术中定位PCNL治疗鹿角形肾结石的临床研究

CT three-dimensional reconstruction combined B-ultrasound and X-ray localized PCNL in treatment of renal staghorn calculi

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.