实时低剂量CT定位引导穿刺和B超引导穿刺在经皮肾镜碎石取石术治疗鹿角形肾结石中的临床疗效对比

Comparison of the efficacy of real-time low-dose CT-guided puncture and B-ultrasound-guided puncture in percutaneous nephrolithotomy for staghorn kidney stones

目的对比实时低剂量CT定位引导穿刺和B超引导穿刺在经皮肾镜碎石取石术治疗鹿角形肾结石中的临床疗效。方法收集本院2016年12月—2020年12月70例鹿角形肾结石患者,随机分为观察组和对照组,每组35例,观察组采用术前送CT室行实时低剂量CT定位引导穿刺建立经皮肾操作工作通道后送手术室行经皮肾镜碎石术,对照组为同一术者采用B超定位引导下穿刺行经皮肾镜碎石术,分别收集两组目标肾盏穿刺成功率、手术碎石时间、术中出血量、一期结石清除率等相关数据进行对比。结果观察组目标肾盏穿刺成功率、一期结石清除率均高于对照组,而手术碎石时间与术中出血量均小于对照组,差异有统计学意义(P<0.05)。结论实时低剂量CT定位引导穿刺,可为经皮肾镜碎石术操作工作通道的建立提供更精准的定位,提高目标肾盏穿刺成功率,缩短手术碎石时间,减少术中出血量,提高鹿角形肾结石经皮肾镜一期结石清除率,同时由于采用比常规剂量更低的低剂量CT平扫引导定位穿刺,能够降低患者接受的辐射剂量。

Objective To compare the clinical efficacy of real-time low-dose CT-guided puncture and B-ultrasound-guided puncture in percutaneous nephrolithotomy(PCNL)for staghorn kidney stones.Methods Seventy patients with staghorn kidney stones in our hospital from December 2016 to December 2020 were randomly divided into an observation group and a control group,with 35 cases in each group.The patients in the observation group were sent to the CT room preoperatively for real-time low-dose CT-guided puncture to establish a working channel for the operation,and then sent to the operating room for PCNL.The patients in the control group underwent PCNL with puncture under the guidance of B-ultrasound by the same surgeon.We collected relevant data such as the success rate of target calyceal puncture,the operation time of lithotripsy,intraoperative blood loss,first-stage stone clearance rate for comparison between two groups.Results The success rate of target calyceal puncture and the rate of first-stage stone clearance in the observation group were higher than those of the control group,while the operation time of lithotripsy and intraoperative blood loss were lower than those of the control group(P<0.05).Conclusion Real-time low-dose CT-guided puncture can provide more accurate positioning for the establishment of operation channel for PCNL.It can improve the success rate of target calyceal puncture with shorter operation time of lithotripsy and less intraoperative blood loss as well as improve the first-stage clearance rate of staghorn kidney stones.Furthermore,compared to the conventional dose CT,low-dose CT plain scan for puncture positioning can ruduce the radiation received by patients.