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目的:探讨在经皮肾镜碎石术围手术期中运用螺旋CT扫描及三维重建技术的临床价值。方法:对68例复杂性肾结石患者运用螺旋CT扫描及三维重建技术进行术前模拟定位,制定最佳的穿刺通道,术中根据CT结果搜寻结石,术后即刻、1、3、5天行CT扫描。结果:本组68例复杂性肾结石中建立手术通道75条,从穿刺到建立第一条手术通道的时间为5～10 min,通道位置完全符合手术前设计72条;手术时间50～110 min;38例结石完全取尽,结石完全清除率55.9%,残留结石碎片者(≤4 mm)22例,残留小结石(>4 mm)8例;术中发生集合系统穿孔5例,胸腔积液者30例,占44.1%;全部患者皆有肾周积液,多者延及盆腔,平均约105.8 ml,此后逐渐吸收;1例集合系统大量积血,术后全部肾脏肾实质皆较术前增厚,但此后逐渐恢复术前状态。结论:螺旋CT扫描能为经皮肾镜碎石术术前提供精确的穿刺径路,术中为寻找结石提供方向,术后能精确发现残存结石的大小、位置及有无出血、灌注液的逆流和外渗,螺旋CT扫描是经皮肾镜碎石术术前、术后较理想的影像学检查。
Objective: To explore the clinical value of percutaneous nephrolithotomy using spiral CT and three-dimensional reconstruction. Methods: Sixty-eight patients with complex nephrolithiasis underwent preoperative simulation and positioning using spiral CT and three-dimensional reconstruction to establish the best puncture channel. According to the results of CT, intraoperative search for stones was performed. Immediately after operation, 1,3,5 days CT scan. Results: Seventy-eight surgical channels were established in 68 complicated renal calculi. The time from puncture to the establishment of the first surgical channel was 5 to 10 min, and the position of the channel was completely consistent with the pre-operative design. The operative time was 50 to 110 min ; Completely removed 38 cases of stones, the complete removal rate of stones was 55.9%, residual stone fragments (≤ 4 mm) in 22 cases, residual small stones (> 4 mm) in 8 cases; intraoperative collection system perforation occurred in 5 cases, pleural effusion 30 cases, accounting for 44.1%; all patients have perirenal effusion, and more extended to the pelvic cavity, an average of about 105.8 ml, then gradually absorbed; a large collection of hematoma collection system, all postoperative renal parenchyma were preoperative Thickening, but then gradually restore the preoperative state. Conclusion: Spiral CT scan can provide accurate puncture path for percutaneous nephrolithotripsy before operation. It can provide the direction for finding stones in operation. The size, location, presence or absence of bleeding and the countercurrent And extravasation, spiral CT scan is percutaneous nephrolithotomy preoperative and postoperative ideal imaging examination.