术前B超标记预定位CT修正定位后术中B超定位在PCNL术中的应用研究

Application study of intraoperative B-ultrasound precise PCNL after preoperative B-ultrasound pre-location with modified CT positioning

目的:探讨一种更加安全、精确、有效的经皮肾镜取石术(PCNL)穿刺定位方式治疗上尿路结石的安全性和有效性。方法:回顾性分析2013年8月—2019年12月我院采用B超预定位CT标记修正定位后术中B超定位行精准PCNL治疗上尿路结石的937例患者的临床资料,其中肾结石851例,输尿管结石86例。手术均采用气管插管全身麻醉,并严格按照我们新的手术步骤进行PCNL。结果:937例患者均按照该方法步骤完成PCNL,一期术后结石清除率(SFR)为86.13%(807/937),平均手术时间为(100.00±28.28)min。130例复杂结石因结石残留行二期PCNL或输尿管软镜碎石术(RIRS),1例患者术后出血行介入栓塞治疗后成功止血,另外1例肝硬化患者术后出血行血浆输注后成功止血。所有病例未发生胸膜、胃肠道等重要器官损伤并发症。结论:采用B超预定位CT标记修正定位后术中B超定位行精准PCNL治疗上尿路结石的安全性、有效性更强,手术步骤流程完全可重复,特别对初学者来说更加实用、更加安全、学习曲线更短,值得在临床推广应用。

Objective:To investigate the safety and effectiveness of a more accurate,effective and safer method of puncturing localization in percutaneous nephrolithotomy(PCNL)to treat upper urinary calculi.Methods:The clinical data of 937patients with upper urinary tract calculi treated by the method of puncturing localization:intraoperative B-ultrasound precise PCNL after preoperative B-ultrasound pre-location with modified CT positioning were retrospectively analyzed in our hospital from August 2013to December 2019,including 851cases of kidney stones and 86cases of ureteral stones.All operations were performed under general anesthesia with endotracheal intubation,and PCNL was performed in strict accordance with our new surgical procedures.Results:All 937patients completed PCNL according to this procedure.The stone clearance rate of the first stage was 86.13%(807/937),and the mean operation time was(100.00±28.28)min.Two stage PCNL or flexible ureteroscopic lithotripsy were performed for 130patients,complex calculi due to residual calculi.Postoperative bleeding in 1patient was successfully stopped after interventional embolization therapy,and postoperative bleeding in another patient with cirrhosis was successfully stopped after plasma infusion.There were no complications of injury to pleura,gastrointestinal tract or other important organs in all cases.Conclusion:It is safe and effective to perform accurate PCNL in the treatment of upper urinary calculi with the method of puncturing localization:intraoperative B-ultrasound precise PCNL after preoperative B-ultrasound pre-location with modified CT positioning,and the surgical procedures are completely repeatable.It is a more practical and safer method for beginners with shorter learning curve,so it's worthy of clinical application.