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目的探讨集合系统CT三维重建帮助经皮肾镜手术(PCNL)精准进行目标肾盏选择和目标肾盏穿刺的可行性和安全性。方法肾结石PCNL患者196例,均行术前腹部泌尿系平片(KUB)、静脉肾盂造影(IVU)、CT平扫和增强扫描,分别获取肾结石、集合系统及肾脏周围器官的CT三维影像,在集合系统三维重建后面观影像上确定最佳PCNL目标肾盏,将确定的目标肾盏通过影像转化技术标识在IVU影像上,C臂机引导下穿刺该目标肾盏建立手术通道。结果所有PCNL手术均按术前的规划实现了精准穿刺目标肾盏建立手术通道,196例患者术中、术后无严重出血、邻近器官损伤等并发症,均未输血。鹿角形肾结石手术无石率为88%,肾盂肾盏结石94.1%。结论通过对影像的技术转化,将CT集合系统三维重建确定的目标肾盏准确标识在IVU影像上,指导PCNL术中对目标肾盏进行精准选择和精准穿刺,建立更加安全的手术通道,最大程度降低PCNL出血和器官损伤等并发症。
Objective To investigate the feasibility and safety of three-dimensional reconstruction of a collection system for percutaneous nephrolithotomy (PCNL) for targeted calyx selection and targeted renal calyceal puncture. Methods A total of 196 PCNL patients with nephrolithiasis were examined with KUB, IVU, CT scan and contrast-enhanced CT before operation. CT images of renal calculi, collecting system and organs around the kidney were obtained respectively. , To determine the best PCNL target calyx in the 3D view of the collection system and to identify the target calyx through the IVU image through image conversion technique. The C-arm machine was used to puncture the target calyx to establish the surgical channel. Results All PCNL surgeries were operated according to the preoperative planning, and the target of calculus was established accurately. There were no transfusions in 196 patients with intraoperative and postoperative complications such as no severe hemorrhage and adjacent organ damage. Antagonistic nephrolithotomy operation rate of 88% stone, pelvis calyx stones 94.1%. Conclusion Through the technical conversion of the images, the target calyxes identified by three-dimensional reconstruction of the CT assembly system are accurately identified on the IVU images to guide the precise selection and precise punctures of the target calyceal during operation in PCNL to establish safer surgical channels to the maximum degree Reduce PCNL bleeding and organ damage and other complications.