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目的:评价预置双穿刺径路技术在经皮肾镜取石术(PCNL)治疗鹿角形肾结石中的应用价值。方法:选择72例单侧鹿角形肾结石患者,采用64排螺旋CT平扫并进行结石三维重建,初步判断至少需要建立双通道,根据重建结果设定两个穿刺目标肾盏。患者均接受B超引导下主通道F22PCNL,必要时行F16MPCNL,记录手术时间、穿刺通道位置及数目、输血例数以及并发症。术后采用CT扫描判断有无结石残留。结果:术中实际穿刺肾盏与术前根据CT三维重建结果设计的目标肾盏完全一致,建立多通道数目与术前预测符合率为79.2%(57/72);一期手术结石取净率为70.8%(51/72),二期或多期结石取净率为81.9%(59/72)。结论:螺旋CT三维重建技术可形象直观地显示结石的立体结构,指导术前穿刺通道的选择、术中结石寻找,预置双穿刺径路技术可降低手术难度,提高结石清除率。
Objective: To evaluate the value of preoperative double puncture technique in percutaneous nephrolithotomy (PCNL) in the treatment of antler kidney stones. Methods: Seventy-two patients with unilateral staghorn kidney stone were selected and scanned by 64-slice spiral CT. Three-dimensional reconstruction of the stone was performed. At least two channels were needed to establish the initial judgment. Two puncture target calves were set according to the reconstruction results. Patients underwent B-guided main channel F22PCNL, F16MPCNL when necessary, and recorded the operation time, the number and location of the puncture channel, the number of blood transfusion and complications. Postoperative CT scan to determine whether there is residual stones. Results: The actual calculus of the calluses during operation was completely consistent with the target calculus designed according to the three-dimensional reconstruction results of CT before operation. The coincidence rate of establishing multi-channel number with preoperative prediction was 79.2% (57/72) For 70.8% (51/72), the rate of second-stage or multi-stage stone removal was 81.9% (59/72). Conclusion: Three-dimensional reconstruction of spiral CT can display the three-dimensional structure of the stone visually and intuitively, guiding the choice of the preoperative puncture channel, looking for the stone in the operation, and presetting the double puncture technique to reduce the operation difficulty and improve the stone clearance rate.