Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Division of Urology, São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2013 Jun;68(6):892-5. doi: 10.6061/clinics/2013(06)27.
Objective parameters in computed tomography (CT) scans that could predict calyceal access during percutaneous nephrolithotomy have not been evaluated. These parameters could improve access planning for percutaneous nephrolithotomy. We aimed to determine which parameters extracted from a preoperative multiplanar reconstructed CT could predict renal calyceal access during a percutaneous nephrolithotomy.
From January 2009 through April 2011, 230 patients underwent 284 percutaneous nephrolithotomies at our institution. Sixteen patients presented with complete staghorn calculi, and 11 patients (13 renal units) were analyzed. Five parameters were extracted from a preoperative reconstructed CT and compared with the surgical results of percutaneous nephrolithotomy.
Fifty-eight calyces were studied, with an average of 4.4 calyces per procedure. A rigid nephroscope was used to access a particular calyx, and a univariate analysis showed that the entrance calyx had a smaller length (2.7 vs. 3.98 cm, p=0.018). The particular calyx to be accessed should have a smaller length (2.22 vs. 3.19 cm, p=0.012), larger angles (117.6 vs. 67.96, p<0.001) and larger infundibula (0.86 vs. 0.61 cm, p=0.002). In the multivariate analysis, the only independent predictive factor for accessing a particular calyx was the angle between the entrance calyx and the calyx to be reached (OR 1.15, 95% confidence interval [CI], 1.053-1.256, p=0.002).
The angle between calyces obtained by multiplanar CT reconstruction is the only predictor of calyx access.
在经皮肾镜取石术中，尚未评估计算机断层扫描（CT）扫描中的客观参数是否可以预测肾盂入路。这些参数可以改善经皮肾镜取石术的入路规划。我们旨在确定从术前多平面重建 CT 中提取的哪些参数可以预测经皮肾镜取石术中的肾盏入路。
2009 年 1 月至 2011 年 4 月，我院 230 例患者共行 284 例经皮肾镜取石术。16 例患者为完全鹿角结石，11 例（13 个肾脏单位）患者纳入分析。从术前重建 CT 中提取 5 个参数，并与经皮肾镜取石术的手术结果进行比较。
研究了 58 个肾盏，每个手术平均有 4.4 个肾盏。使用刚性肾镜进入特定肾盏，单因素分析显示入口肾盏长度较小（2.7cm 与 3.98cm，p=0.018）。将要进入的特定肾盏应具有较小的长度（2.22cm 与 3.19cm，p=0.012）、较大的角度（117.6°与 67.96°，p<0.001）和较大的漏斗（0.86cm 与 0.61cm，p=0.002）。在多变量分析中，进入特定肾盏的唯一独立预测因素是入口肾盏与要到达的肾盏之间的角度（OR 1.15，95%置信区间 [CI]，1.053-1.256，p=0.002）。
多平面 CT 重建获得的肾盏之间的角度是肾盏入路的唯一预测因子。
