非实时CT预定位、实时超声修正定位在经皮肾镜术通道建立中的应用  

Application of non-real time CT urography in combination with real time B ultrasound surveillance for PCNL tract establishment

作　　者：吴杰英[1] 黄文涛[1] 阮星星[1] 王德娟[1] 方友强[1] 胡成[1] 邱剑光[1] 

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2013年第5期5-9,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：2010年广东省科技计划项目(2010B031600083)

摘　　要：目的探讨非实时CT预定位、实时超声修正定位技术在经皮肾镜术(PCNL)通道建立中的应用,研究该方法建立通道的准确性、安全性及有效性。方法研究组纳入44例明确诊断为复杂性肾结石并接受经皮肾镜碎石术的患者,术前均行泌尿系CTU平扫+增强检查,根据CT设计穿刺路线,在CT上获得影像学皮肤表面穿刺点和肾脏表面穿刺点,测量最小穿刺距离、安全穿刺距离、肾脏表面穿刺点距离肾上/下极距离、皮肤表面穿刺点距离肋尖距离。术中由麻醉师协助控制呼吸深度,于超声监视下对预定穿刺点及穿刺路径进行修正定位,准确建立工作通道。以此前同一术者未采用该定位方式时所行的99例PCNL手术病例作为对照组。比较两组的手术时间、出血量、输血率、一次结石取净率、介入栓塞率、肾周血肿发生率等情况,进而评估该定位方式的准确性、安全性及有效性。结果研究组出血量明显少于对照组(14.9±9.9 g/L vs 38.0±20.8 g/L,t=-6.627,P<0.05)。研究组术后发热等非出血性并发症的发生率明显低于对照组(χ2=5.610,P<0.05)。研究组介入率比对照组下降(2.3%vs8.1%,χ2=1.742,P>0.05)。两组在手术时间、一次结石取净率、肾周血肿发生率、输血率等方面相近,差异没有统计学意义。结论非实时CT预定位、术中实时超声修正定位能高效、安全、准确指导PCNL术中通道的建立,能降低经皮肾镜术的出血量及并发症发生率,是对传统定位方法的有效补充。Objective To evaluate the accuracy, safety and efficacy of a new locating technique using non-real time CT urography （CTU） for pre-locating combined with real time B uhrasound for corrected locating during PCNL tract establishment. Methods Forty-four patients with complex renal calculi who underwent large tract and tubeless PCNL procedures in lateral semisupine lithotomy position were enrolled into observation group. Non-real time CT urography was performed in all of the 44 patients. Pre-locating of the percutaneous puncture point was done according to CTU image, the shortest puncture distance and safe puncture distance were measured. Ninty-nine patients who underwent PCNL procedures by the same surgeon were enrolled into the control group. Same techniques were used in control group, however, the location method in observation group was not applied. The operation time, blood loss, transfusion rate, stone clearance rate, rate of interventional therapy and perinephric hematoma were compared. Results Blood loss in observation group was significant lower than that in control group （14.9＋9.9 g/L vs 38.0＋20.8 g/L, t=-6.627, P〈0.05）. Non-hemorrhagic complication rate in observation group was significant lower thanthat in control group （X2=5.610, P〈O.05）. Interventional therapy was performed in 1 paitent of observation group and 8 patients of control group, though there was no statistical difference, the intervention rate was still much lower in observation group than that in control group （2.3% vs 8.1%,X2=1.742, P〉O.05）. The operation time, transfusion rate, stone clearance rate and rate of perinephric hematoma between two groups were similar, without statistic difference. Conclusions The new locating techque that non-real time pre-locating by CTU, combine with real time corrected locating by B ultrasound can high effectively, safely and accurately guided PCNL tract establishment. It can decrease blood loss and complication rate, and is an important supplement of traditional locating method.

关 键 词：CT 超声 经皮肾镜 定位 非实时 

分 类 号：R691.4[医药卫生—泌尿科学]