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目的:探讨螺旋CT扫描在微创经皮肾镜取石术(MPCNL)中的应用价值。方法:对157例上尿路结石患者术前行俯卧位螺旋CT扫描,了解结石三维结构,确定穿刺目标肾盏及其穿刺方向及深度,以完成MPCNL的治疗。结果:157例患者术前螺旋CT扫描检查可清楚显示上尿路结石在上尿路的准确位置及结石间的位置关系、肾盂形态、肾盏颈部形态、中后组肾盏结构。所有患者均穿刺成功,其中一期手术取石143例,二期手术取石14例;单通道取石148例,双通道取石9例,结石总取净率为91.6%,1例术后出现迟发性出血,经保守治疗治愈。结论:螺旋CT扫描有助于设计合适的经皮肾通道,提供精确的穿刺方向及深度,提高穿刺成功率、结石清除率,减少或避免术后并发症。
Objective: To investigate the value of spiral CT in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods: 157 cases of upper urinary tract stones were performed preoperative prone position spiral CT scan to understand the three-dimensional structure of the stone, to determine the puncture target calyx and its puncture direction and depth to complete the treatment of MPCNL. Results: The preoperative helical CT scan of 157 patients clearly shows the location of the upper urinary tract stones in the upper urinary tract and the relationship between the stones, the morphology of the renal pelvis, the neck morphology of the calyces, and the structure of the calyx in the middle and late groups. All patients were successful in puncture, including 143 cases of primary stone removal in 14 cases and 14 cases of secondary stone removal in operation. 148 cases of single-channel stone removal, 9 cases of dual-channel stone extraction and 91.6% Bleeding, cured by conservative treatment. Conclusion: Spiral CT scan is helpful to design proper percutaneous renal access, provide accurate puncture direction and depth, improve puncture success rate, stone clearance rate and reduce or avoid postoperative complications.