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目的:探讨螺旋CT辅助定位联合C型臂在微创经皮肾镜取石术中的应用价值。方法:对15例输尿管上段结石、43例肾结石共58例63侧患者(CT组)在行经皮肾镜取石术前先行俯卧位螺旋CT扫描,确定穿刺点、穿刺角度和深度,术中据CT测量结果行盲穿,穿刺成功后及碎石毕再行C型臂检查以明确穿刺针及导丝进入肾脏收集系统位置、结石有无残留及部位,并与同期8例输尿管上段结石、23例肾结石共31例33侧(C臂组)直接在C型臂下行微创经皮肾镜取石术者进行比较。结果:CT组58例63侧平均穿刺1.22次,C型臂平均使用2.22次,均明显低于C臂组31例33侧的1.79次和4.52次(t=3.538,P=0.001和t=6.614,P=0.001);但CT组残石率为22.22%(14/63),与C臂组残石率30.30%(10/33)比较,差异无统计学意义(x~2=0.754,P=0.385)。结论:螺旋CT辅助定位联合C型臂行微创经皮肾镜取石术能有效提高经皮肾穿刺成功率并减少C型臂的应用,降低X线的辐射量,尤其适用于复杂肾结石的微创治疗及该项业务的推广应用。
Objective: To explore the value of spiral CT-assisted positioning combined with C-arm in minimally invasive percutaneous nephrolithotomy. Methods: Fifteen cases of upper ureteral calculi and 43 cases of renal calculi in 58 cases of 63 patients (CT group) underwent preoperative prone position spiral CT scan before percutaneous nephrolithotomy. The puncture point, puncture angle and depth were determined. Blind paracentesis, CT puncture and grading were performed again after C-arm examination to clear the needle and guide wire into the renal collection system position, with or without residual stones and sites, and the same period in 8 cases of upper ureteral calculi, 23 A total of 31 cases of renal calculi 33 cases (C arm group) directly in the C-arm underwent minimally invasive percutaneous nephrolithotomy were compared. Results: On the 63 side of CT group, the average puncture was 1.22 times in 58 cases and 2.22 times in C arm, which were significantly lower than those in 33 cases of C arm in 31 cases (1.79 and 4.52) (t = 3.538, P = 0.001 and t = 6.614 , P = 0.001). However, the rate of residual stone in CT group was 22.22% (14/63), which was not significantly different from the residual rate of 30.30% (10/33) in C group (x 2 = 0.754, P = 0.385). Conclusion: Spiral CT-assisted positioning and C-arm minimally invasive percutaneous nephrolithotomy can effectively improve the success rate of percutaneous nephrolithotomy and reduce the application of C-arm, and reduce the radiation dose of X-ray, especially for complicated nephrolithiasis Minimally invasive treatment and the promotion and application of the business.