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目的探讨彩色多普勒超声联合CT三维成像在经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)中的价值。方法肾结石患者120例,采用CT血管造影:CT动脉成像技术/CT静脉成像技术(CTA/CTV)辅助彩色多普勒超声引导下精确定位穿刺,建立经皮肾通道行PCNL。结果 120例患者均成功行PCNL术,手术时间40—150分钟,平均(75±63)分钟;术中出血量20~200 m1,平均出血量(70±50)ml。术后3~5天行腹部平片复查,12例残石直径>4 mm,一次性净石率为90.0%,二期净石率达到100%;3例出现迟缓性大出血,其中1例经选择性肾动脉栓塞,2例经用止血药物,绝对卧床休息,夹闭造瘘管和牵拉造瘘管气囊行压迫性止血等措施,出血停止。无肾切除与死亡患者。随访3~6个月,无结石复发及严重并发症。结论彩色多普勒超声联合CT三维成像定位行PCNL术,可避免血管损伤,减轻因盲点穿刺而造成的医源性血管损伤出血,提高PCNL术的成功率,减少并发症的发生。
Objective To investigate the value of color Doppler ultrasonography and CT three-dimensional imaging in percutaneous nephrolithotomy (PCNL). Methods One hundred and twenty patients with nephrolithiasis underwent CT angiography with CT angiography (CT / CTV) assisted by color Doppler ultrasound to locate the puncture and establish percutaneous renal access to PCNL. Results All the 120 patients underwent PCNL successfully. The operation time was 40-150 minutes with an average of (75 ± 63) minutes. The blood loss was 20-200 m1 and the average amount of bleeding was 70 ± 50 ml. Postoperative 3 to 5 days abdominal plain film review, 12 cases of residual stone diameter> 4 mm, a one-time net rate of 90.0%, two net stone rate of 100%; 3 cases of delayed bleeding, of which 1 case of Selective renal artery embolism, 2 cases with hemostatic drugs, absolute bed rest, closed fistula and traction fistula balloon compression hemostasis and other measures to stop bleeding. No nephrectomy and death of patients. Follow-up 3 to 6 months, no recurrence of stones and serious complications. Conclusion Color Doppler ultrasound combined with CT three-dimensional imaging of PCNL can avoid vascular injury, reduce the bleeding caused by iatrogenic vascular injury caused by blind puncture, improve the success rate of PCNL and reduce the incidence of complications.