四象限预定位法协助建立经皮肾取石通道的效果  

Effect of four-quadrant pre-positioning method in assisting the establishment of percutaneous nephrolithotomy access

作　　者：丁小举 金志波[1] 杨俊福[1] 贾占奎[1] 杨锦建[1] Ding Xiaoju;Jin Zhibo;Yang Junfu;Jia Zhankui;Yang Jinjian(Department of Urology Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院泌尿外科,郑州450052

出　　处：《中华泌尿外科杂志》2024年第12期918-924,共7页Chinese Journal of Urology

摘　　要：目的探讨经皮肾镜取石术(PCNL)中应用四象限预定位法同步CT检查结果,辅助彩色多普勒超声建立理想穿刺通道的效果。方法回顾性分析郑州大学第一附属医院2021年5月至2023年7月收治的113例肾结石患者的病例资料,根据手术方法将患者分为研究组和对照组。研究组64例,2022年6月至2023年7月采用四象限预定位法辅助彩色多普勒超声定位穿刺点并行PCNL;对照组49例,2021年5月至2022年5月行PCNL。根据结石分布特征将研究组和对照组各分为3个亚组,亚组1为单个肾盂或单个肾盏结石,研究组27例、对照组20例,结石长径分别为(34.27±7.69)mm和(39.77±11.34)mm;亚组2为肾盂合并单个肾盏结石、>2个肾盏多发结石,研究组19例、对照组15例,结石长径分别为(45.77±9.50)mm和(40.94±11.34)mm;亚组3为鹿角形结石或铸型结石,研究组20例、对照组17例,结石长径分别为(60.03±11.59)mm和(58.41±15.01)mm。3个亚组中研究组和对照组的性别、年龄、身高、体质量、结石侧别、结石长径、结石CT值比较差异均无统计学意义(P<0.05)。四象限预定位法是根据多层螺旋CT检查结果和患者解剖特征,以12肋尖为原点,以身体横轴和纵轴分别为X轴、Y轴,建立“四象限”,于象限内定位理想穿刺点;术中根据12肋尖体表定位,于患者体表同步“四象限”及理想穿刺点,协助彩色多普勒超声引导建立理想穿刺通道。比较每个亚组中研究组和对照组的穿刺通道建立时间、穿刺首盏符合率(符合标准:单个肾孟或肾盏结石,首个穿刺通道可实现净石率>90%;多个肾盏结石或鹿角形结石,首个穿刺通道可实现净石率>50%)、手术时间、术中出血量、净石率、术后并发症等指标。结果研究组和对照组比较,亚组1的通道建立时间分别为(4.74±2.25)min和(7.00±3.13)min(P=0.006);亚组2的通道建立时间分别为(6.94±2.12)min和(9.80±2.83)min(P=0.002),首盏符合率分别为94.Objective To investigate the effect of using"Four-Quadrant Pre-Positioning Method"combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy(PCNL).Methods A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023.Patients were divided into two groups based on the surgical method:the study group and the control group.The study group consisted of 64 patients who,from June 2022 to July 2023,underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization.The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022.Based on the distribution of stones,both groups were further divided into three subgroups:subgroup 1:single renal pelvis or single renal calyx stones(study group:27 patients,control group:20 patients).Stone length was(34.27±7.69)mm vs.(39.77±11.34)mm,respectively.Subgroup 2:renal pelvis combined with a single renal calyx stone,or multiple stones in more than two renal calyces(study group:19 patients,control group:15 patients).Stone length was(45.77±9.50)mm vs.(40.94±11.34)mm,respectively.Subgroup 3:staghorn or cast stones(study group:20 patients,control group:17 patients).Stone length was(60.03±11.59)mm vs.(58.41±15.01)mm,respectively.There were no significant dfferences in gender,age,height,weight,side of the stone,stone length,or stone CT values between the subgroups(P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patients anatomical characteristics.The 12th rib apex is taken as the origin,and the body's transverse and longitudinal axes are defined as the X and Y axes,respectively,to create the"Four Quadrants."The ideal puncture point is located within these quadrants.During the procedure,based on surface markings of the 12th rib apex,the"Four Quadra

关 键 词：四象限预定位法 理想穿刺通道 经皮肾镜取石术 设计穿刺点 

分 类 号：R69[医药卫生—泌尿科学]