C臂CT激光引导穿刺联合DSA下经皮肾盂置管引流治疗盆腔恶性肿瘤致肾盂积水的安全性和有效性  

Safety and efficacy of C-arm CT laser-guided percutaneous renal pelvic catheter drainage under DSA in the treatment of hydronephrosis caused by pelvic malignancy

作　　者：耿翔 黎海亮 胡鸿涛 郭晨阳 程洪涛 姚全军 赵亚楠 赵可 Geng Xiang;Li Hailiang;Hu Hongtao;Guo Chenyang;Cheng Hongtao;Yao Quanjun;Zhao Yanan;Zhao Ke(Department of Minimally-Invasive Intervention,The Afiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)微创介入科,郑州450008

出　　处：《中华泌尿外科杂志》2023年第4期276-281,共6页Chinese Journal of Urology

摘　　要：目的探讨C臂CT激光引导穿刺联合数字减影血管造影(DSA)下经皮肾盂置管引流治疗盆腔恶性肿瘤所致肾盂积水的安全性和有效性。方法回顾性分析2020年2月至2021年8月郑州大学附属肿瘤医院收治的56例因盆腔恶性肿瘤致输尿管梗阻患者的病例资料, 男10例, 女46例。年龄(54.0±10.1)岁。盆腔恶性肿瘤分别为结直肠癌7例, 膀胱癌3例, 宫颈癌36例, 子宫内膜癌3例, 卵巢癌2例, 胃癌盆腔转移4例, 盆腔肉瘤1例。56例共71侧肾盂扩张。肾盂扩张12~50 mm。肾盂积水程度为轻度36侧, 中度27侧, 重度8侧。术前血红蛋白(103.83±23.41)g/L, 尿素氮(9.90±6.22) mmol/L, 肌酐(155.80±146.83) μmol/L。穿刺及置管引流术中, 患者取俯卧位, 采用C臂CT扫描并规划穿刺路径, DSA机平板探测器的激光定位皮肤穿刺点。局麻后在非透视状态下于患者呼气末闭气时调整穿刺针的穿刺方向, 使皮肤穿刺点、穿刺针针尾、激光定位点呈"三点一线"的状态以达到预设的穿刺角度, 然后根据规划的穿刺深度完成肾盂穿刺, 肾盂穿刺成功后在DSA下行经皮肾盂外引流管置入或输尿管支架管置入。记录术中肾盂穿刺次数、穿刺时间、辐射剂量、肾盂外引流管置入角度与预设穿刺角度的偏差, 以及术后血红蛋白变化、肾功能恢复情况和并发症情况。结果本组56例71侧肾盂穿刺和置管引流均顺利完成, 手术成功率100.0%(71/71)。首针穿刺成功率为97.2%(69/71), 有2侧于术中第二次穿刺成功。肾盂穿刺时间(1.9±1.8)min。术中辐射剂量(2.7±1.5)mSV。53侧置入肾盂外引流管, 其中29侧外引流管置入角度与预设角度相同, 24侧存在3°以内偏差;18侧置入输尿管支架管。术后第1天复查血红蛋白(104.23±23.02)g/L, 与术前相比差异无统计学意义(P=0.877);尿素氮(5.31±1.99) mmol/L(P=0.008), 肌酐(62.25±16.72) μmol/L(P=0.002), 与术前相比差异均有统计学意义。所有患者Objective To investigate the safety and efficacy of C-arm CT laser-guided puncture combined with digital subtraction angiography(DSA)for percutaneous renal pelvic catheter drainage in the treatment of hydronephrosis caused by pelvic malignancy.Methods A retrospective analysis was performed on the data of 56 patients with ureteral obstruction caused by pelvic malignancy admitted to the Affiliated Cancer Hospital of Zhengzhou University from February 2020 to August 2021,including 10 males and 46 females.The mean age of the patients was(54.0±10.1)years old.The causes were colorectal cancer(7 cases),bladder cancer(3 cases),cervical cancer(36 cases),endometrial cancer(3 cases),ovarian cancer(2 cases),pelvic metastasis of gastric cancer(4 cases)and pelvic sarcoma(1 case).There were 71 sides of renal pelvis dilation in 56 patients,with the degree of dilation ranging from 1.2cm to 5.Ocm.The degree of hydronephrosis was mild on 36 sides,moderate on 27 sides,and severe on 8 sides.Preoperative blood urea nitrogen(9.90±6.22)mmol/L and creatinine(155.80±146.83)μmol/L.During the puncture and catheter drainage,the patient was placed in the prone position,the C-arm CT scan was used to plan the puncture path,and the laser positioning of the DSA flat panel detector was used to determine the skin puncture point.With local anesthesia,the puncture direction of the puncture needle was adjusted to make the skin puncture point,the tail of the puncture needle,and the laser fixation point present a state of"threepoints in one-line"when the patient stopped breathing temporarily at the end of expiratory breath in a nonfluoroscopic state,so as to achieve the preset puncture angle.Subsequently,pyelocentesis was completed according to the planned puncture depth.After successful pyelocentesis,percutaneous external renal drainage tube insertion or ureteral stents were performed under DSA.The number of renal pelvis puncture,puncture time,radiation dose,deviation of external renal drainage tube insertion angle from puncture angle,as well as po

关 键 词：肾盂积水 C臂CT 激光引导 盆腔恶性肿瘤 

分 类 号：R737[医药卫生—肿瘤] R692[医药卫生—临床医学]