CAJ | 학술논문

目的探讨经皮肾镜取石术中C型臂X光机检查结石的必要性.方法从2011年10月至2013年12月期间 ,在466例上尿路阳性结石患者经皮肾镜取石术结束前 ,经皮肾镜认为结石已经干净 ,再用C型臂X光机检查 ,观察有无结石残余 ,以进一步取石或决定二期手术处理.将C型臂X光机检查前后的结石清除率进行统计学分析(McNemar检验).结果 C型臂X光机透视发现 ,输尿管上段结石见有>4 mm结石碎片残留2例 ,肾盂结石4例 ,肾盏结石3例 ;再次经原通道或另再建立通道后入镜 ,除1例外 ,全部成功取出.鹿角形结石见有>4 mm结石残余24例 ,再次入镜 ,成功取出15例 ;多发肾结石见有>4 mm结石残余25例 ,再次入镜 ,成功取出19例.术后2~4 d复查尿路平片 ,术中C型臂X光机确认有结石残余者 ,术后均证实结石残余 ,C型臂X光机认为结石已取净的患者中仍有5例残留.各种结石的清除率在C型臂X光机检查后均有提升 ,鹿角形肾结石( P<0 .001 )、多发肾结石( P<0 .001 )提升显著.结论经皮肾镜取石术结束前需用C型臂X光机确认结石是否残余 ,尤其是对于鹿角形肾结石和多发肾结石 ,可明显提高结石清除率.
목적 탐토경피신경취석술중C형비X광궤검사결석적필요성.방법 종2011년10월지2013년12월기간 ,재466례상뇨로양성결석환자경피신경취석술결속전 ,경피신경인위결석이경간정 ,재용C형비X광궤검사 ,관찰유무결석잔여 ,이진일보취석혹결정이기수술처리.장C형비X광궤검사전후적결석청제솔진행통계학분석(McNemar검험).결과 C형비X광궤투시발현 ,수뇨관상단결석견유>4 mm결석쇄편잔류2례 ,신우결석4례 ,신잔결석3례 ;재차경원통도혹령재건립통도후입경 ,제1예외 ,전부성공취출.록각형결석견유>4 mm결석잔여24례 ,재차입경 ,성공취출15례 ;다발신결석견유>4 mm결석잔여25례 ,재차입경 ,성공취출19례.술후2~4 d복사뇨로평편 ,술중C형비X광궤학인유결석잔여자 ,술후균증실결석잔여 ,C형비X광궤인위결석이취정적환자중잉유5례잔류.각충결석적청제솔재C형비X광궤검사후균유제승 ,록각형신결석( P<0 .001 )、다발신결석( P<0 .001 )제승현저.결론 경피신경취석술결속전수용C형비X광궤학인결석시부잔여 ,우기시대우록각형신결석화다발신결석 ,가명현제고결석청제솔.
Objective To evaluate the efficacy of C-arm in determining residual stones during percutaneous nephrolithot-omy (PCNL) .Methods From Oct .2011 to Dec .2013 ,466 patients with upper urinary tract radiopaque stones were treated with PCNL ,and were diagnosed as stone-free by percutaneous nephroscopy .Then C-arm was used to determine whether there were residual stones to determine the secondary procedure .The stone-free rate before and after C-arm check were analyzed with McNemar test .Results The C-arm found upper ureteral stones in 2 cases ,renal pelvis stones in 4 cases ,calyx stones in 3 cases ,staghorn stones >4 mm in 24 cases ,and multiple renal stones in 25 cases .After a second PCNL ,most residual stones were successfully removed .KUB radiography 2 days after operation found that cases diagnosed to have residual stones by C-arm did have residual stones ,while 5 cases diagnosed as stone-free still had residual stones .By using C-arm technique ,the stone-free rate of all kinds of calculi was increased ,including that of staghorn calculi and multiple kidney calculi (both P<0 .001) .Con-clusion It is necessary to confirm the residual stones by C-arm intra percutaneous nephrolithotomy ,especially for staghorn calculi and multiple kidney stones ,which can significantly improve the stone-free rate .