Application of computed tomography-ultrasound image fusion technique in collecting system puncture: a prospective randomized controlled study
-
摘要: 目的 探索CT-超声融合技术指导经皮肾穿刺的有效性及安全性。方法 将2020年4月—2021年2月在我院行经皮肾镜取石术(PCNL)的肾结石患者纳入前瞻性研究，随机分为CT-超声组和超声组。收集并比较患者的一般资料、共定位方式、融合时间、定位时间、穿刺通道、结石清除率等资料。结果 共纳入43例患者，CT-超声组20例，超声组23例。两组患者术前的一般资料均差异无统计学意义。CT-超声组的融合时间为(4.37±0.67) min。CT-超声组和超声组的定位时间分别为(2.69±0.36) min和(3.51±0.57) min，差异有统计学意义(P < 0.001)；手术时间分别为(71.15±13.87) min和(81.65±15.46) min，差异有统计学意义(P < 0.05)。CT-超声组建立的PCN通道较超声组少，差异有统计学意义(P < 0.05)。两组患者术后血红蛋白下降、Clavien-Dindo并发症、术后住院天数和结石清除率均差异无统计学意义。结论 与传统的超声引导技术相比，CT-超声融合技术可以缩短超声定位时间，减少所需的PCN通道数量，缩短手术时间。Abstract: Objective To demonstrate a novel CT-ultrasound image fusion technique for guiding percutaneous renal puncture in clinical practice.Methods Patients with kidney stones in our hospital from April 2020 to February 2021 were employed in the study, then they were randomly divided into CT-ultrasound group and ultrasound group. The general condition of patients, fusion method, fusion time, ultrasound screening time, simulated puncture channel and so on were compared between the two groups.Results A total of 43 patients were enrolled, including 20 in the CT-ultrasound group and 23 in the ultrasound group. In the CT-ultrasound group, the fusion time was (4.37±0.67) min. The ultrasound screening time of the two groups were (2.69±0.36) min and (3.51±0.57) min, respectively, and the operation time were (71.15±13.87) min and (81.65±15.46) min, respectively. The differences were statistically significant (P < 0.01 and P < 0.05, respectively). In the CT-ultrasound group, we established fewer PCN channels, and the difference was of statistical significance (P < 0.05).Conclusion Compared with traditional ultrasound guidance, CT-ultrasound image fusion technique can shorten the ultrasound screening time, reduce the number of PCN channels, and shorten the operation time.
-
Key words:
- renal stone /
- percutaneous nephrolithotomy /
- computed tomography /
- ultrasound /
- puncture
-
-
表 1 CT-超声组与超声组术前临床资料的比较
例(%)，X±S，M(Min，Max) 项目 超声组(23例) CT-超声组(20例) P值 性别 0.589 男 12(52.2) 13(65.0) 女 11(47.8) 7(35.0) 年龄/岁 53.30±11.81 52.90±9.19 0.902 BMI/(kg/m2) 23.15±3.58 23.49±2.76 0.729 患侧肾别 0.904 右 13(56.5) 10(50.0) 左 10(43.5) 10(50.0) 既往同侧手术史 5(21.7) 3(15.0) 0.862 结石最大截面积/mm2 234.61±99.90 231.80±164.91 0.946 皮肾通道距离/mm 79.57±14.42 81.20±11.91 0.690 梗阻程度 0.379 轻度积水 14(60.9) 14(70.0) 中度积水 3(13.0) 4(20.0) 重度积水 6(26.1) 2(10.0) 受累及肾盏数目/个 2.43±0.90 2.65±1.14 0.492 结石CT值/HU 998.61±245.32 1102.20±428.64 0.329 S.T.O.N.E评分 7(6，9) 7(6，8) 0.825 
下载: 导出CSV
表 2 CT-超声组与超声组术中资料的比较
例(%)，X±S，M(Min，Max) 项目 超声组(23例) CT-超声组(20例) P值 手术时间/min 81.65±15.46 71.15±13.87 0.025 共定位部位 门静脉 5(25.0) 肾长轴、肾结石(右肾) 5(25.0) 肾长轴、肾结石(左肾) 10(50.0) 融合时间/min 4.37±0.67 定位时间/min 3.51±0.57 2.69±0.36 < 0.001 穿刺部位 0.788 腋后线十二肋间 5(21.7) 6(30.0) 腋后线十二肋下 18(78.3) 14(70.0) 穿刺肾盏 0.900 上组肾盏 1(4.3) 2(10.0) 中组肾盏 22(95.7) 18(90.0) 通道建立时长/min 5.28±0.36 5.18±0.43 0.339 穿刺满意度 7(6，8) 8(7，9) < 0.001 输尿管软镜使用 6(26.1) 5(25.0) 0.935 PCN通道数目 0.044 1 15(65.2) 19(95.0) 2 8(34.8) 1(5.0)
下载: 导出CSV
表 3 CT-超声组与超声组术后资料的比较
例(%)，X±S 项目 超声组(23例) CT-超声组(20例) P值 术后血红蛋白下降/(g/L) 15.26±12.09 14.10±13.14 0.764 Clavien-Dindo并发症分级 0.405 无 16(69.6) 17(85.0) Ⅰ级 7(30.4) 3(15.0) 总住院天数/d 8.91±1.98 8.65±2.06 0.672 术后住院天数/d 5.48±1.73 4.95±1.93 0.350 初始结石清除率(1周) 19(82.6) 17(85.0) 1 最终结石清除率(1个月) 19(82.6) 18(90.0) 1
下载: 导出CSV
-
[1] Goodwin WE, Casey WC, Woolf W. Percutaneous trocar(needle)nephrostomy in hydronephrosis[J]. J Am Med Assoc, 1955, 157(11): 891-894. doi: 10.1001/jama.1955.02950280015005
[2] Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis[J]. Eur Urol, 2016, 69(3): 475-482. doi: 10.1016/j.eururo.2015.07.041
[3] de la Rosette JJ, Laguna MP, Rassweiler JJ, et al. Training in percutaneous nephrolithotomy-a critical review[J]. Eur Urol, 2008, 54(5): 994-1001. doi: 10.1016/j.eururo.2008.03.052
[4] Rodrigues PL, Rodrigues NF, Fonseca J, et al. Kidney targeting and puncturing during percutaneous nephrolithotomy: recent advances and future perspectives[J]. J Endourol, 2013, 27(7): 826-834. doi: 10.1089/end.2012.0740
[5] Brisbane W, Bailey MR, Sorensen MD. An overview of kidney stone imaging techniques[J]. Nat Rev Urol, 2016, 13(11): 654-662. doi: 10.1038/nrurol.2016.154
[6] Ahn SJ, Lee JM, Lee DH, et al. Real-time US-CT/MR fusion imaging for percutaneous radiofrequency ablation of hepatocellular carcinoma[J]. J Hepatol, 2017, 66(2): 347-354. doi: 10.1016/j.jhep.2016.09.003
[7] Liu FY, Yu XL, Liang P, et al. Microwave ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma undetectable by conventional ultrasonography[J]. Eur J Radiol, 2012, 81(7): 1455-1459. doi: 10.1016/j.ejrad.2011.03.057
[8] Miyagawa T, Ishikawa S, Kimura T, et al. Real-time Virtual Sonography for navigation during targeted prostate biopsy using magnetic resonance imaging data[J]. Int J Urol, 2010, 17(10): 855-860. doi: 10.1111/j.1442-2042.2010.02612.x
[9] Hamamoto S, Unno R, Taguchi K, et al. A New Navigation System of Renal Puncture for Endoscopic Combined Intrarenal Surgery: Real-time Virtual Sonography-guided Renal Access[J]. Urology, 2017, 109: 44-50. doi: 10.1016/j.urology.2017.06.040
[10] Xu ZF, Xie XY, Kuang M, et al. Percutaneous radiofrequency ablation of malignant liver tumors with ultrasound and CT fusion imaging guidance[J]. J Clin Ultrasound, 2014, 42(6): 321-330. doi: 10.1002/jcu.22141
[11] Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique[J]. Scand J Urol Nephrol, 1976, 10(3): 257-259. doi: 10.1080/21681805.1976.11882084
[12] Hajiha M, Baldwin DD. New Technologies to Aid in Percutaneous Access[J]. Urol Clin North Am, 2019, 46(2): 225-243. doi: 10.1016/j.ucl.2019.01.001
[13] Da RM, Milot L, Sugar L, et al. A prospective comparison of MRI-US fused targeted biopsy versus systematic ultrasound-guided biopsy for detecting clinically significant prostate cancer in patients on active surveillance[J]. J Magn Reson Imaging, 2015, 41(1): 220-225. doi: 10.1002/jmri.24710
[14] Xu KW, Huang J, Guo ZH, et al. Percutaneous nephrolithotomy in semisupine position: a modified approach for renal calculus[J]. Urol Res, 2011, 39(6): 467-475. doi: 10.1007/s00240-011-0366-x
-
图(1)
表(3)
计量
- 文章访问数: 776
- PDF下载数: 196
- 施引文献: 0