CT three-dimensional reconstruction combined B-ultrasound and X-ray localized PCNL in treatment of renal staghorn calculi
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摘要: 目的：探讨CT三维重建辅助B超联合X线术中定位经皮肾镜取石术（PCNL）治疗肾鹿角形结石的临床应用价值。方法：回顾性分析2016年6月—2019年6月在我院实施PCNL治疗的21例完全性鹿角形结石患者资料，所有患者术前均行结石CT三维重建，术中联合B超和X线定位穿刺建立通道，均建立16F或18F通道鞘。结果：21例患者均成功实施手术治疗，一期完全清除结石18例，3例残留小盏内结石患者于1个月后二期软镜碎石顺利，21例患者术后3个月复查均无结石残留。21例患者建立通道数均不超过2个，其中单通道6例，双通道15例，手术时间70~130 min，平均（92.3±26.8） min，术后平均住院时间为5 d，无感染性休克以及大出血病例。结论：完全性鹿角形肾结石患者，术前CT结石三维成像，术中联合B超和X线定位穿刺建立通道，有助于以尽可能少的通道最大限度清除结石，利于提高结石清除率，是一种安全、高效的治疗方式，值得临床应用以及推荐。Abstract: Objective: To investigate the application value and clinical effect of CT three-dimensional reconstruction combined B-ultrasound and X-ray localized percutaneous nephrolithotomy in the treatment of renal staghorn stones.Methods: Twenty-one patients with staghorn calculi who underwent urinary CT scan and three-dimensional reconstruction were enrolled into PCNL group from June 2016 to June 2019. All of them underwent 16 F or 18 F channel in operation, and were treated by PCNL under intraoperative X-ray, B-ultrasound guiding.Results: Twenty-one cases were completed successfully without conversion to open surgery. One-stage surgery was done on 21, but three of them needed second-stage surgery because of residual calculi. The stone free rate was 18/21(85.71%) after one-stage surgery and 21/21(100%) after 3 months surgery. In 21 patients, the number of established channels was no more than 2, including 6 in single channel and 15 in double channels. Moreover, the average operation time was(92.3±26.8) min(range, 70-130) min, and the postoperative average hospital stay was 5 days. No hematorrhea occurred.Conclusion: CT three-dimensional reconstruction combined X-ray and B-ultrasound guiding in PCNL for staghorn calculi is safe and effective for its high stone clearance and less bleeding. It is worth clinical application and recommendation.
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