MSCT在复杂性肾结石经皮肾镜取石术中的临床应用

The Clinical Application of MSCT in Percutaneous Nephrolithotomy for Complex Renal Calculus

目的探讨多层螺旋CT(MSCT)三维成像技术在复杂性肾结石经皮肾镜取石术的术前及术后的应用价值。方法方便选取2017年8月—2019年2月在该院泌尿外科进行手术治疗的66例肾脏多发结石、鹿角状结石的患者进行术前CT检查,并应用CT三维成像处理技术对CT图像进行处理,根据结石空间分布特点建立经皮肾镜建立的理想通道进行腔内碎石取石术,术后通过MSCT复查观察结石残留情况、肾积水改善情况、术后并发症情况及双J管、造瘘管位置情况。结果66例(78侧)复杂性肾结石患者,有51例多发结石,15例鹿角状结石。通过结合肾脏的CT三维图像而建立经皮肾镜通道。51侧采用单一通道,27侧加做了第二通道。术后通过多层螺旋CT复查16侧肾盏内有残余小结石(结石最大径>2 mm),结石清除率为79.5%(62/78);术前有肾积水患者情况均有不同程度改善;术后出现严重出血3例(腹膜后巨大血肿需行介入栓塞治疗);双J管、造瘘管位置异常3例。结论在复杂性肾结石经皮肾镜取石手术中,术前应用MSCT三维成像处理技术可提供肾盂肾盏集合系统的清晰图像,并可以准确地发现肾结石,清晰显示它的大小、形状和位置,生动展示结石的三维形状和空间位置关系及其与肾盂肾盏的关系,有利于明确经皮肾穿刺部位,提高手术安全性;术后通过MSCT复查可以清晰观察结石残留情况、肾积水改善情况、术后并发症情况及双J管、造瘘管位置情况,对临床了解病情及决定下一步治疗具有重要的指导性意义。

Objective To explore the application value of multilayer spiral CT(MSCT)three-dimensional imaging technology before and after percutaneous nephrolithotomy for complex renal calculi.Methods From August 2017 to February 2019,66 patients with multiple kidney stones and staghorn stones who underwent surgical treatment in the urology department of the hospital were conveniently selected and examined by preoperative CT,and the CT images were processed by CT three-dimensional imaging processing technology.Establish an ideal channel established by percutaneous nephroscope according to the spatial distribution of the stones for intracavitary lithotripsy.After the operation,MSCT was used to observe the residual stones,the improvement of hydronephrosis,postoperative complications,double J tube and fistula tube location situation.Results 66 cases(78 sides)of patients with complicated kidney stones,51 cases of multiple stones,15 cases of staghorn stones.The percutaneous nephroscope channel was established by combining the three-dimensional CT images of the kidney.A single channel was used on the 51 side,and a second channel was added on the 27 side.After operation,multi-slice spiral CT was used to reexamine the small residual stones in the 16 sides of the renal calyces(the maximum diameter of the stones>2 mm),and the stone clearance rate was 79.5%(62/78);patients with hydronephrosis before the operation had different degrees improvement;3 cases of severe bleeding occurred after operation(large retroperitoneal hematoma required interventional embolization treatment);3 cases of abnormal position of double J tube and fistula tube.Conclusion In the percutaneous nephrolithotomy of complex kidney stones,the preoperative application of MSCT three-dimensional imaging processing technology can provide a clear image of the renal pelvis and calyx collection system,and can accurately find the kidney stone,clearly showing its size,shape and location,vividly display the three-dimensional shape and spatial position of the stone and its relationship with the renal pelvis and renal calyx,which is conducive to clarifying the site of percutaneous renal puncture and improving the safety of the operation;after the MSCT review,the residual status of the stone and the improvement of hydronephrosis can be clearly observed the condition,postoperative complications and the position of the double J tube and fistula tube are of important guiding significance for the clinical understanding of the disease and the decision of the next treatment.