3D可视化经皮肾穿刺规划及术中辅助定位引导PCNL的应用

Application of 3D visualized percutaneous renal puncture planning and intraoperative assisted guidance in PCNL

目的:介绍3D可视化经皮肾穿刺规划及术中辅助定位方法,并探索其在经皮肾镜取石术(PCNL)中的临床应用疗效。方法:回顾性分析2018年10月—2020年10月我中心同一医疗组采用PCNL治疗的160例肾结石患者,根据穿刺规划方法分为两组,3D规划组(76例)为采取3D穿刺规划及术中辅助定位,对照组(84例)为常规PCNL。比较两组患者穿刺定位时间、手术时间、出血量、术后结石清除率、并发症发生率、术后住院时间的差异。结果:3D规划组首个穿刺定位平均时间短于对照组(P<0.001)。3D规划组一期PCNL双通道穿刺比例显著大于常规组(23.6%vs.6.0%,P=0.001)。3D规划组一期结石清除率及总结石清除率显著大于对照组(85.5%vs.67.8%,P=0.009;92.1%vs.79.8%,P=0.026);住院时间短于对照组[(4.7±1.0)d vs.(5.1±1.0)d,P=0.004]。两组在平均手术出血量、手术时间及术后并发症差异无统计学意义。结论:3D可视化经皮肾穿刺规划可提升PCNL穿刺通道的精准性、提高结石清除率,尤其适用复杂性肾结石合理规划一期多通道碎石,具有较好的临床应用价值。

Objective: To introduce the 3 D visualized percutaneous puncture planning and intraoperative assisted access method, and explore its clinical effect in percutaneous nephrolithotomy(PCNL). Methods: A total of 160 patients with renal stones treated with PCNL in our center from October 2018 to October 2020 were retrospectively analyzed. Of all cases were divided into two groups: 3 D planning group(76 cases) who underwent 3 D preoperative puncture planning and intraoperative assisted guidance, and control group(84 cases) who received conventional ultrasound-guided PCNL. The puncture time, operative time, blood loss, stone-free rate, postoperative complication and postoperative hospitalization time were compared between the two groups. Results: The mean first tracts puncture time in the 3 D planning group was shorter than that in the control group(P<0.001). The proportion of bi-channel puncture in the 3 D planning group was significantly higher than that in the conventional group(23.6%vs. 6.0%,P=0.001). The one-stage stone-free rate and final stone-free rate in the 3 D planning group were significantly higher than those in the control group(85.5% vs. 67.8%, P=0.009;92.1% vs. 79.8%, P=0.026), and the hospital stay was shorter than the control group [(4.7±1.0)d vs.(5.1±1.0)d, P=0.004]. There was no significant difference between the two groups in blood loss, operative time or postoperative complications. Conclusion: The 3 D visualized percutaneous puncture planning improves the accuracy of puncture access and stone free rate in PCNL. It was especially suitable for planning reasonable multiple tracts for complex renal stones.