Pan Feng, Li Wen-cheng, Liang Hua-geng, Ju Wen, Fan Min, Pang Zi-li, Xiao Ya-jun, Zeng Fu-qing
Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430022, China.
Zhonghua Yi Xue Za Zhi. 2013 Jun 11;93(22):1740-2.
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.
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.
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% (110/119) 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.
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.
评估术前计算机断层扫描尿路造影（CTU）三维重建、术中放射学及超声引导下经皮肾镜取石术（PCNL）治疗复杂性肾结石的安全性和有效性。
在这项回顾性研究中，我们总结了2008年12月至2011年12月在我院接受治疗的210例复杂性肾结石患者的临床资料。一站式诊断治疗组（n = 119）根据CTU成像及三维重建设计最佳穿刺路径，在超声及放射学引导下穿刺建立经皮通道，采用EMS系统行PCNL。对照组（n = 91）行PCNL时未采用放射学引导。观察穿刺成功率、平均穿刺时间、平均手术时间、术中失血量及一期手术后结石清除率。术后随访至2012年6月。
与对照组相比，一站式诊断治疗组穿刺成功率更高[98.3%（117/119）对92.3%（84/91），P = 0.037]，手术时间更短[97.8 ± 13.20对110.0 ± 14.73分钟，P = 0.043]，一期手术后结石清除率更高[92.4%（110/119）对83.5%（76/91），P = 0.037]。平均穿刺时间[15.3 ± 3.7对13.9 ± 3.9分钟，P = 0.398]及术中失血量[195.8 ± 84.15对263.3 ± 82.06毫升，P = 0.059]差异无统计学意义。未发生严重并发症。随访期间未发现结石复发。
一站式诊断治疗方案（CTU三维重建加放射学、超声引导下PCNL）可明确穿刺路径，提高穿刺成功率及结石清除率，减少PCNL并发症。
