术前低剂量CT预定位及术中B超修正定位在经皮肾镜术中的应用  

Application of preoperative low-dose CT pre-positioning and intraoperative B-ultrasound correction localization-guided puncture technique in percutaneous nephrolithotomy

作　　者：王鑫 覃智标[2] 陈思桦 张家宙[3] 毕革文[2] 雷华[2] 李起广 Wang Xin;Qin Zhibiao;Chen Sihud;Zhang Jiazhou;Bi Gewen;Lei Hud;Li Qiguang(Graduate School of Guangxi University of Traditional Chinese Medicine,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning 530021,China;Department of Urology,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning 530021,China;Department of Radiology,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning 530021,China)

机构地区：[1]广西中医药大学研究生院,南宁530021 [2]广西中医药大学第一附属医院泌尿外科 [3]广西中医药大学第一附属医院放射科

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第3期223-227,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：广西医疗卫生技术开发与推广应用项目(S2021080);广西中医药大学研究生院校级创新课题(YCXJ202107)。

摘　　要：目的探讨术前在CT室行低剂量CT预定位,结合术中实时B超修正定位引导穿刺行经皮肾镜碎石取石术(PCNL)治疗复杂性肾结石的安全性和有效性。方法选取2020年8月至2022年8月广西中医药大学第一附属医院收治的82例诊断为复杂性肾结石并需行PCNL的患者,按随机对照原则分为观察组与对照组,每组41例,观察组予术前在CT室采用低剂量CT扫描,CT扫描结果传输至螺旋CT工作站,进行三维重建,根据拟穿刺目标肾盏从CT的横断面获取穿刺点部位,并测量出进针深度和角度。按CT提供的数据在患者体表预先标记穿刺点,术中在B超监视下对预定穿刺点及穿刺路径进行修正定位,准确建立工作通道后行PCNL。对照组经B超引导定位建立穿刺通道行PCNL,比较两组目标肾盏穿刺成功率、手术碎石时间、术中出血量、一期结石清除率、术后并发症等相关数据。结果观察组目标肾盏穿刺成功率、一期结石清除率均高于对照组,而手术碎石时间与术中出血量均小于对照组,差异有统计学意义(P<0.05)。结论术前低剂量CT预定位术中B超修正定位引导穿刺技术,可以提高复杂性肾结石目标肾盏穿刺成功率及结石清除率,缩短手术碎石时间,降低术中出血量,在复杂性肾结石的治疗中具有很好的应用价值。Objective To investigate the safety and efficacy of preoperative low-dose CT pre-positioning in the CT room,combined with intraoperative real-time B-ultrasound correction positioning-guided puncture for percutaneous nephrolithotomy(PCNL)in the treatment of complex renal calculi.Methods From August 2020 to August 2022,82 patients diagnosed with complicated nephrolithiasis requiring PCNL were selected and divided into observation group and control group according to the principle of randomized control,with 41 cases in each group,and the observation group was subjected to low-dose CT scan in the CT room before surgery,and the CT scan results were transmitted to the spiral CT workstation for three-dimensional reconstruction.According to the target renal calyces,the puncture site was obtained from the cross-section of the CT and the depth and angle of the needle were measured.The data provided by CT were guided to pre-mark the puncture point on the patient's body,and the predetermined puncture point and path were corrected and positioned under B-ultrasound monitoring during the operation,and the working channel was accurately established and the PCNL was performed.The control group underwent B-ultrasound-guided positioning to establish the puncture channel and performed PCNL,and the relevant data such as the success rate of calycesis,the time of lithotripsy,intraoperative blood loss,primary stone clearance,and postoperative complications were compared between the two groups.Results The success rate of target calyceal puncture and the first-stage stone clearance rate in the observation group were higher than those in the control group,while the lithotripsy time and intraoperative blood loss were both less than those in the control group,and the differences were statistically significant.Conclusions Preoperative low-dose CT pre-positioning and intraoperative B-ultrasound correction positioning-guided puncture technology can improve the success rate of target calyx puncture and stone clearance rate for complex kidney sto

关 键 词：CT预定位 术中超声定位 经皮肾镜 肾结石 

分 类 号：R699.2[医药卫生—泌尿科学]