Li Z M, Jiao D C, Han X W, Zhou X L, Xu M, Yang H
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 22;100(47):3801-3805. doi: 10.3760/cma.j.cn112137-20200524-01638.
To investigate the feasibility and advantages of establishing percutaneous nephrolithotomy pathway guided by C-arm CT. The data of 258 patients who were established a percutaneous nephrolithotomy pathway under the guidance of C-arm CT in the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2019 were retrospectively analyzed, including168 males and 90 females, and aged 19-88 (60±11) years. There were 84 cases of single stone, 174 cases of multiple stone, and 18 cases of cast stone. The stone size was 9-42 (22±6) mm. Among them, dual access was established in 18 cases, and nephrolithotomy access was established in 276 cases. The three-dimensional guiding function of C-arm CT was used to puncture the target calyces and establish the percutaneous nephrolithotomy pathway. The pathway was successfully established in 258 cases at the first time, with a success rate of 93.5%; successfully established in 15 cases at the second time, with a success rate of 98.9%; and unable to establish in 3 cases, with a failure rate of 1.1%. The operation time was (7.9-32.5) min, with an average of (16±5) min. The lithotripsy time was (25-115) min, with an average of (43±8) min. The intraoperative blood lose was (45-420) ml, with an average of (75±11) ml. There were 23 cases with postoperative calculus residual (8.3%). Postoperative complications included fever in 86 cases (33.3%), which improved after symptomatic treatment. Postoperative hematuria was observed in 128 patients (49.6%) with varying degrees of gross hematuria, among which 2 patients (0.72%) were treated with arterial embolization due to excessive bleeding and ineffective conservative treatment, while the hematuria disappeared after symptomatic treatment in the rest of the patients. The method of establishing percutaneous nephrolithotomy pathway under the guidance of C-arm CT was simple to operate. Especially for patients without hydronephrosis, this method had a high success rate and low complications, which was worthy of clinical promotion and reference.
探讨在C型臂CT引导下建立经皮肾镜取石术通道的可行性及优势。回顾性分析2012年1月至2019年12月在郑州大学第一附属医院介入医学科在C型臂CT引导下建立经皮肾镜取石术通道的258例患者的资料，其中男性168例，女性90例，年龄19 - 88（60±11）岁。单发结石84例，多发结石174例，铸型结石18例。结石大小为9 - 42（22±6）mm。其中，建立双通道18例，建立单通道经皮肾镜取石通道276例。利用C型臂CT的三维导向功能穿刺目标肾盏并建立经皮肾镜取石术通道。首次成功建立通道258例，成功率93.5%；第二次成功建立通道15例，成功率98.9%；3例未能建立通道，失败率1.1%。手术时间为（7.9 - 32.5）分钟，平均（16±5）分钟。碎石时间为（25 - 115）分钟，平均（43±8）分钟。术中出血量为（45 - 420）毫升，平均（75±11）毫升。术后结石残留23例（8.3%）。术后并发症包括发热86例（33.3%），经对症治疗后好转。术后128例患者（49.6%）出现不同程度肉眼血尿，其中2例（0.72%）因出血过多且保守治疗无效行动脉栓塞治疗，其余患者经对症治疗后血尿消失。C型臂CT引导下建立经皮肾镜取石术通道的方法操作简便。尤其对于无肾积水的患者，该方法成功率高、并发症少，值得临床推广借鉴。
