摘要
目的：研究结合CT术前标线的3D模拟穿刺在经皮肾镜中应用的有效性和安全性。方法：选取我院2012～2014年行经皮肾镜碎石的病例153例,根据患者术前影像学资料,选择目标肾盏,在CT片上标线,测量其与脊柱中线的间距和上下距离。设计穿刺位置、角度和深度,模拟在人体的相应穿刺路径,并使用记号笔在患者体表做相应标记。术中首先利用膀胱镜行输尿管插管做人工肾积水,也可作为C型臂定位时逆行造影用。用B超在预先标记的路径上引导穿刺,或逆行造影用C型臂在预先标记的路径上引导穿刺。结果：153例患者均穿刺并碎石成功,定位穿刺时间为（6.8±1.4）min,其中140例在B超定位下一次穿刺目标肾盏成功,13例经2次或以上才成功,其中1例因肾周脂肪太厚,穿刺路径太长而B超不能准确定位,改行C型臂下逆行造影,同样方法定位穿刺进入深度12cm,获得成功。所有患者术后均未出现严重感染、高热、气胸、假性动脉瘤、肠管损伤等并发症,无输血和介入栓塞病例。回顾对比2008～2012年采用单纯X线定位穿刺的300例经皮肾镜手术,其中165例须2次或以上术中瞬时X线摄像才穿刺成功,8例出血较多术后给予输血,其中3例行超选择动脉栓塞。结论：术前CT 3D模拟穿刺定位方法简单实用,能提高经皮肾镜定位穿刺的有效性和安全性,具有推广价值。
Objective：To evaluate the accuracy and safety of PCNL by 3Dsimulative puncture based on preoperative CT image.Method：From 2012 to 2014,153 cases with kidney stones were obtained from our department.According to the preoperative imaging data,the target kidney was selected.We measured the distance between the point and spinal midline in the CT image,and designed the angle and depth of puncture.Then we simulated the puncture path of human body,and marked it on the surface of the patients.During the operation the ureter intubation and artificial hydronephrosis were completed with cystoscope.Then the puncture was conducted guided by Bultrasound or C armed X-ray.Result：All 153 cases were treated successfully.Time of localization and puncture was（6.8±1.4）min.One-time puncture was successfully completed in 140 cases.Another 13 procedures were successful with additonal C armed X-ray due to obesity,enter depth 12 cm with the same method.No postoperative complications of infection,fever,pneumothorax,pseudoaneurysm or intestinal injury was found.Also,no blood transfusion or arterial embolization was needed.Other 300 cases using apure X-ray during PCNL from 2008 to 2012were compared,in which 165 cases were successfully punctureed by two or more times of X-ray imaging.Eight cases were given blood transfusion,and three of them underwent super-selective embolization.Conclusion：Three-dimensional simulative puncture based on preoperative CT image is a simple and practical method,which could improve the accuracy and safety of PCNL.
出处
《临床泌尿外科杂志》
2016年第6期553-555,共3页
Journal of Clinical Urology
关键词
经皮肾镜碎石术
3D
模拟
定位
穿刺
percutaneous nephrolithotomy
three-dimensional
simulation
localization
puncture
