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目的探讨自制格栅定位器与多排螺旋CT三维重建视频引导动态定位在经皮肾穿刺微造瘘(minimally invasivepercutaneous nephrostomy,MPCN)术中的临床应用价值。方法 2008年9月～2012年6月,对58例急性肾功能衰竭、肾脏复杂结石、肾积水患者,局麻下采用自制格栅(grille)定位器辅助16排螺旋CT三维重建视频动态定位,行精确定位经皮肾穿刺微造瘘,行微创经皮肾镜碎石取石术(MPCNL)30例,仅行MPCN 28例(其中8例双侧)。结果 58例均一次成功完成MPCN,术中出血≤5 ml,无周围组织器官损伤。结论自制格栅定位器辅助16排螺旋CT三维重建视频引导快速动态精确定位,具有MPCN成功率高、可视性强的优点,而且安全,操作简便,工作通道建立快捷,出血及并发症少,定位精确,值得推广应用。
Objective To investigate the clinical value of video-guided dynamic localization of homemade grid locator and multi-slice spiral CT in minimally invasive percutaneous nephrostomy (MPCN). Methods From September 2008 to June 2012, 58 patients with acute renal failure, complex renal calculi and hydronephrosis were treated with a self-made grille positioner to assist the three-dimensional reconstructed video dynamic positioning of 16-slice spiral CT Thirty patients underwent minimally invasive percutaneous nephrolithotomy (MPCNL) and 28 patients underwent MPCN (eight of them were bilateral). Results All of the 58 patients successfully completed MPCN at one time. The intraoperative blood loss was less than or equal to 5 ml and there was no tissue injury in the surrounding tissues. Conclusion The self-made grid locator assists 16-slice spiral CT three-dimensional reconstruction to guide the rapid dynamic precise positioning. It has the advantages of high success rate of MPCN and strong visualization. It is safe, easy to operate, quick to establish working channel, less bleeding and complications, Positioning accuracy, it is worth promoting application.