实时低剂量CT定位穿刺经皮肾镜碎石术治疗无积水肾结石的效果

Effect of Real-Time Low-Dose CT Localization and Percutaneous Nephrolithotripsy in the Treatment of Non Hydronephrosis Renal Calculi

目的:探讨实时低剂量CT定位穿刺在经皮肾镜治疗无积水肾结石的临床疗效。方法:对2019年3月至2020年6月于广西中医药大学第一附属医院行实时低剂量CT定位穿刺造瘘术,并通过造瘘口行经皮肾镜碎石取石术的25例无积水肾结石患者进行分析。结果:25例患者均行单侧经皮肾镜碎石取石术,均能成功在CT室建立经皮肾通道,穿刺成功率为100%,共建立30个工作通道,其中单通道取石21例,双通道3例,三通道1例,3例患者行二期手术,一期结石清除率为88%(22/25),手术时间50 min~180 min,平均(88.80±26.03)min;术中出血量20 mL~150 mL,平均(70.00±34.40)m L;住院时间6~12天,平均(8.52±1.33)天。1例患者术后出现发热,经抗感染对症处理后体温恢复正常,2例患者在CT室行定位穿刺术后在等待手术的过程中由于活动较为频繁,导致造瘘管脱落,所有患者术后均未出现大出血,肾周脏器损伤等并发症。结论:实时低剂量CT定位穿刺在经皮肾镜治疗无积水肾结石中具有良好的临床疗效,其穿刺成功率以及一期结石清除率均较高,术中出血量少,手术时间短。采用低剂量CT定位,在大大降低患者接受的辐射量的同时能够对无积水肾结石进行准确定位,并且安全、可行。

Objective:To investigate the clinical efficacy of real-time low-dose CT localization puncture in percutaneous nephroscopy for the treatment of non hydronephrosis renal calculi.Methods:From March 2019 to June 2020 in the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,25 patients with non hydronephrosis renal calculi underwent real-time low-dose CT location puncture fistula and percutaneous nephrolithotomy through the fistula were analyzed.Results:Unilateral percutaneous nephrolithotripsy was performed in all 25 patients,and percutaneous renal channels were successfully established in the CT room with a puncture success rate of 100%.A total of 30 working channels were established,including 21 cases of single-channel stone extraction,3 cases of double-channel stone extraction,and 1 case of three-channel stone extraction.3 patients underwent secondary surgery,and the first-stage stone clearance rate was 88%(22/25).The operation time was 50-180min,with an average of(88.80±26.03) min.Intraoperative blood loss was 20-150ml,with an average of(70.00±34.40) mL.The length of hospital stay was 6-12 days,with an average of(8.52±1.33) days.One patient developed fever after surgery,and the body temperature returned to normal after anti-infection symptomatic treatment;two patients lost fistulas due to their frequent activities while waiting for surgery after location puncture in CT room;all patients did not have massive bleeding,perirenal organ injury and other complications after surgery.Conclusion:Real-time low-dose CT localization puncture has good clinical efficacy in percutaneous nephrolithotripsy for the treatment of hydronephrosis renal calculi,with high puncture success rate and primary stone clearance rate,less intraoperative blood loss and short operation time.Low-dose CT localization can greatly reduce the amount of radiation patients receive while accurate positioning of non hydronephrosis renal calculi,and is safe and feasible.