CT平扫肾脏矢状位重建后认知影像融合在超微经皮肾镜取石术中的临床应用  

Clinical application of cognitive image fusion with non-enhanced CT with renal sagittal reconstruction for super-mini percutaneous nephrolithotomy

作　　者：尹冰德 何昶 陆旭伟 郭锥锋 杨帆[1] 何敏坷 黄嘉琦 巫嘉文[1] 王杭 YIN Bingde;HE Chang;LU Xuwei;GUO Zhuifeng;YANG Fan;HE Minke;HUANG Jiaqi;WU Jiawen;WANG Hang(Department of Urology,Minhang Hospital,Fudan University,Shanghai 211099;Department of Uro-logy,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属闵行医院泌尿外科,上海211099 [2]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《现代泌尿外科杂志》2021年第6期485-488,524,共5页Journal of Modern Urology

摘　　要：目的探讨CT平扫肾脏矢状位重建后认知影像融合在超微经皮肾镜取石术(SMP)中的应用,评估其在B超定位下穿刺SMP的有效性及安全性。方法选取2019年6月至2020年5月我院行SMP治疗的肾结石及输尿管上段结石患者纳入回顾性研究,CT平扫肾脏矢状位重建联合超声引导下SMP及传统术中超声引导下SMP分为CT-US组、US组两组。两组患者SMP术中均采用相同方式建立通道,使用钬激光碎石联合负压清石系统清除结石。对比两组患者的目标盏定位时间、手术时间、出血量、结石清除率、输血率、严重并发症发生情况等相关指标。结果本研究纳入患者共53例,CT-US组28例,男性18例,女性10例;US组25例,男性14例,女性11例。CT-US组定位及穿刺成功时间(14.9±3.5)min,显著短于US组(30.6±7.1)min,差异有统计学意义(P<0.05)。CT-US组手术时间为(44.6±9.2)min,显著短于US组为(63.1±14.7)min,差异有统计学意义(P<0.05)。CT-US组术后血红蛋白平均下降(10.46±4.5)g/L,低于US组(16.9±10.1)g/L,差异有统计学意义(P<0.05)。CT-US组和B超组均未输血,差异无统计学意义(P=1.0)。CT-US组和US组的结石清除率分别为89.2%(25/28)和84.0%(21/25),差异无统计学意义(P=0.05)。CT-US组均未发生感染性休克等严重并发症(0/28),US组出现2例术后脓毒血症(2/25),差异有统计学意义。结论CT平扫肾脏矢状位重建后认知影像融合下SMP安全、有效,有利于精准建立经皮肾通道、优化手术流程、提高手术成功率及安全性。Objective To investigate the application of cognitive image fusion after renal sagittal reconstruction of non-enhanced CT scan in super-mini percutaneous nephrolithotomy(SMP)and to evaluate its efficacy and safety in SMP under ultrasound.Methods Patients with renal calculi and upper ureteral calculi treated with SMP in our hospital during Jun.2019 and May 2020 were included in the retrospective study and divided into CT-US group which used renal sagittal reconstruction of non-enhanced CT scan combined with ultrasound-guided SMP and the US group which used traditional intraoperative ultrasound-guided SMP.The channels were established in the same way during SMP operation in both groups,and calculi were removed with holmium laser lithotripsy combined with negative pressure lithotripsy.The target calix localization time,operation time,bleeding volume,stone-clearance rate,blood transfusion rate and serious complications were compared between the two groups.Results This study involved 53 patients,inlcuding 28 in the CT-US group(18 male and 10 female),and 25 in the US group(14 male and 11 female).The localization time and operation time were(14.9±3.5)min and(44.6±9.2)min respectievly in the CT-US group,which were significantly shorter than those in the US group(30.6±7.1)min and(63.1±14.7)min,(P<0.01,P<0.05).The hemoglobin decrease in the CT-US group was(10.46±4.5)g/L,which was significantly lower than that in the US group(16.9±10.1)g/L(P<0.01).No blood transfusion was needed in either groups(P=1.0).The stone-clearance rate was 89.2%(25/28)in the CT-US group and 84.0%(21/25)in the US group,with no difference(P=0.05).No serious complications such as septic shock occurred in the CT-US group(0/28),but sepsis occurred in 1 case and septic shock in 2 cases in the US group(2/25),and the difference was statistically significant.Conclusion Cognitive image fusion after renal sagittal reconstruction of non-enhanced CT scan in SMP is safe and effective,which can help to estabish accurate percutaneous channels,optimize surgica

关 键 词：CT平扫 经皮肾镜 超声 

分 类 号：R692.4[医药卫生—泌尿科学]