Department of Urology, The Second People's Hospital of China Three Gorges University, The Second People's Hospital of Yichang, Yichang, China.
Department of Ultrasound, The Second People's Hospital of China Three Gorges University, The Second People's Hospital of Yichang, Yichang, China.
J Endourol. 2021 Apr;35(4):436-443. doi: 10.1089/end.2020.0564. Epub 2020 Oct 30.
To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in percutaneous nephrolithotomy (PCNL) for kidney stone patients without hydronephrosis. Patients with nondilated collecting system kidney stones who underwent PCNL between October 2018 and December 2019 at our hospital were enrolled in this study. Patients who met the inclusion criteria were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided PCNL group. The operation results of the two groups were compared, including the number of attempts for effective puncture, duration to effective puncture, stone clearance rate, blood loss, postoperative complications, and hospital stay. Fifty-six patients with a nondilated collecting system who underwent PCNL for 60 kidneys were included in this study, including 4 patients who underwent bilateral PCNL due to bilateral renal stones. There were 30 kidneys in each group. All patients successfully underwent PCNL. The CEUS-guided PCNL group had more accurate punctures, with a higher effective rate of one puncture and shorter puncture time. There was no statistically significant difference in stone clearance rate between the two groups. Four cases of double channels were established in the conventional US-guided PCNL group, while there was only one case in the CEUS-guided PCNL group. In the CEUS-guided PCNL group, most cases (96.7%, 29/30) had no or only mild complications, which were significantly better than the conventional US-guided PCNL group (76.7%, 23/30). The mean postoperative hemoglobin loss in the CEUS-guided PCNL group was 9.5 (range 1-25) g/L, which was significantly lower than 15.5 (range 5-52) g/L in the conventional US-guided PCNL group. The CEUS technique can improve visibility of the nondilated renal collecting system, facilitate selection of suitable calix, and identify renal calix fornix. It also benefits needle placement in patients with a nondilated collecting system.
探讨对比增强超声（CEUS）在无积水肾结石患者经皮肾镜取石术（PCNL）中的临床价值。本研究纳入了 2018 年 10 月至 2019 年 12 月在我院接受 PCNL 的非扩张性集合系统肾结石患者。符合纳入标准的患者被随机分为两组：CEUS 引导下 PCNL 组和常规超声（US）引导下 PCNL 组。比较两组的手术结果，包括有效穿刺次数、有效穿刺时间、结石清除率、出血量、术后并发症和住院时间。
本研究共纳入 56 例非扩张性集合系统肾结石患者的 60 个肾脏，其中 4 例因双侧肾结石行双侧 PCNL。每组各有 30 个肾脏。所有患者均成功接受了 PCNL。CEUS 引导下 PCNL 组穿刺更准确，一次穿刺有效率更高，穿刺时间更短。两组结石清除率无统计学差异。常规 US 引导下 PCNL 组建立双通道 4 例，CEUS 引导下 PCNL 组仅 1 例。CEUS 引导下 PCNL 组大多数病例（96.7%，29/30）无或仅有轻度并发症，明显优于常规 US 引导下 PCNL 组（76.7%，23/30）。CEUS 引导下 PCNL 组术后平均血红蛋白丢失量为 9.5（1-25）g/L，明显低于常规 US 引导下 PCNL 组的 15.5（5-52）g/L。
CEUS 技术可以提高非扩张性肾集合系统的可视性，有助于选择合适的肾盏，识别肾盂穹窿。它还有利于非扩张性集合系统患者的针放置。
