CAJ | 학술논문

目的评价术前CT尿路成像(CTU)三维重建结合术中X线和B超实时引导穿刺建立通道,采用EMS系统行经皮肾镜碎石术(PCNL)的“一站式”诊疗方案在复杂性肾结石中的应用价值.方法回顾性分析华中科技大学同济医学院附属协和医院泌尿外科2008年12月至2011年12月收治的210例复杂肾结石患者临床资料,其中119例纳入“一站式”方案诊疗组,术前行CTU及三维重建规划设计穿刺路径,采用B超和X线实时引导穿刺建立通道,应用EMS系统行经皮肾镜碎石术.余91例术中无X线监测行经皮肾镜碎石术病例纳为对照组,统计分析两组间1次穿刺成功率、平均通道建立时间、平均手术时间、术中平均出血量及Ⅰ期结石清除率等指标.术后随访至2012年6月.结果 “一站式”方案诊疗组1次穿刺成功率98.3％ (117/119),高于对照组92.3％(84/91),差异有统计学意义(P =0.037),手术时间(97.8±13.2)min较对照组(110.0±14.7) min缩短(P=0.043),且Ⅰ期结石清除率92.4％ (110/119)较对照组83.5％ (76/91)高(P =0.037).两组平均通道建立时间分别为(15.3±3.7)min和(13.9±3.9)min、术中平均出血量分别为(195.8±84.2)ml和(263.3±82.1)ml,差异均无统计学意义(均P＞0.05).两组均无严重并发症发生,随访期间未见结石复发.结论 CTU三维重建结合X线、B超引导建立通道行PCNL的“一站式”诊疗方案,有助于规划最佳手术路径,提高穿刺成功率和Ⅰ期结石清除率,减少穿刺和手术并发症.
목적 평개술전CT뇨로성상(CTU)삼유중건결합술중X선화B초실시인도천자건립통도,채용EMS계통행경피신경쇄석술(PCNL)적“일참식”진료방안재복잡성신결석중적응용개치.방법 회고성분석화중과기대학동제의학원부속협화의원비뇨외과2008년12월지2011년12월수치적210례복잡신결석환자림상자료,기중119례납입“일참식”방안진료조,술전행CTU급삼유중건규화설계천자로경,채용B초화X선실시인도천자건립통도,응용EMS계통행경피신경쇄석술.여91례술중무X선감측행경피신경쇄석술병례납위대조조,통계분석량조간1차천자성공솔、평균통도건립시간、평균수술시간、술중평균출혈량급Ⅰ기결석청제솔등지표.술후수방지2012년6월.결과 “일참식”방안진료조1차천자성공솔98.3％ (117/119),고우대조조92.3％(84/91),차이유통계학의의(P =0.037),수술시간(97.8±13.2)min교대조조(110.0±14.7) min축단(P=0.043),차Ⅰ기결석청제솔92.4％ (110/119)교대조조83.5％ (76/91)고(P =0.037).량조평균통도건립시간분별위(15.3±3.7)min화(13.9±3.9)min、술중평균출혈량분별위(195.8±84.2)ml화(263.3±82.1)ml,차이균무통계학의의(균P＞0.05).량조균무엄중병발증발생,수방기간미견결석복발.결론 CTU삼유중건결합X선、B초인도건립통도행PCNL적“일참식”진료방안,유조우규화최가수술로경,제고천자성공솔화Ⅰ기결석청제솔,감소천자화수술병발증.
Objective To evaluate the safety and efficacy of preoperative computed tomography urography (CTU) three-dimensional reconstruction,intraoperative radiology and ultrasound guidance followed by percutaneous nephrolithotomy (PCNL) in the treatment of complex renal calculi.Methods We summarized the clinical data of 210 patients with complex renal calculi treated at our hospital from December 2008 to December 2011 in this retrospective study.In the one-stop diagnosis and treatment group (n =119),the optimal puncture approach was designed according to CTU imaging and three-dimensional reconstruction.Percutaneous track was established by ultrasound and radiology guided puncture.PCNL was performed with EMS system.The control group (n =91) underwent PCNL without radiological guidance.The success rate of puncture,mean accessing time,mean operative duration,intraoperative volume of blood loss and stone-free rate after one operative session were observed.Post-operative follow-ups were conducted until June 2012.Results Compared to the control group,the one-stop diagnosis and treatment group showed a higher success rate of puncture [98.3％ (117/119) vs 92.3％ (84/91),P =0.037],a shorter operative duration [97.8 ± 13.20 vs 110.0 ± 14.73 min,P =0.043] and a higher stone-free rate after one operative session [92.4％ (1 10/119) vs 83.5％ (76/91),P =0.037].No significant difference was detected in the mean accessing time [15.3 ± 3.7 vs 13.9 ± 3.9 min,P =0.398] or intraoperative volume of blood loss [195.8 ± 84.15 vs 263.3 ± 82.06 ml,P =0.059].No severe complications occurred.No recurrence of calculi was noted during the follow-up period.Conclusion One-stop diagnosis and treatment plan (CTU 3-D reconstruction plus radiology,ultrasound guidance followed by PCNL) may identify the puncture path,improve the successful rate of puncture and stone-free rates and reduce the complications of PCNL.