[1]曹溆 曾宇枭 王跃力**.以CT图像数据为基础的肾脏数字三维成像在经皮肾镜碎石术治疗复杂肾结石中的应用[J].中国微创外科杂志,2021,01(7):624-628.
　Cao Xu,Zeng Yuxiao,Wang Yueli..Application of Threedimensional Digital Reconstruction Renal Imaging Based on CT Data in the Treatment of Complex Renal Calculi by Percutaneous Nephrolithotomy[J].Chinese Journal of Minimally Invasive Surgery,2021,01(7):624-628.
点击复制

以CT图像数据为基础的肾脏数字三维成像在经皮肾镜碎石术治疗复杂肾结石中的应用()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年7期
页码:
624-628
栏目:
临床研究
出版日期:
2021-07-25

文章信息/Info

Title:
Application of Threedimensional Digital Reconstruction Renal Imaging Based on CT Data in the Treatment of Complex Renal Calculi by Percutaneous Nephrolithotomy
作者:
曹溆 曾宇枭 王跃力**
（中国人民解放军联勤保障部队第920医院泌尿外科，昆明650000）
Author(s):
Cao Xu;  Zeng Yuxiao;  Wang Yueli.
Department of Urology, No.920 Hospital of Joint Logistics Support Force, Kunming 650000, China
关键词:
经皮肾镜碎石术; 肾脏数字三维成像; 复杂肾结石
Keywords:
Percutaneous nephrolithotomy; Threedimensional digital renal imaging; Complex renal calculi
文献标志码:
A
摘要:
目的探讨以CT图像数据为基础的肾脏数字三维成像在经皮肾镜碎石术(percutaneous nephrolithotomy，PCNL)治疗复杂肾结石中的应用价值。方法2018年1月~2019年12月16例复杂上尿路结石在PCNL术前依据CT图像数据进行数字三维重建后规划手术(A组），同期16例复杂上尿路结石利用CT图像进行规划手术（B组），比较2组手术时间、出血量、输血率、住院时间、并发症发生率和术后4周一期清石率。结果2组患者均成功行PCNL，数字化成像三维模型能够直观地反映肾脏主要血管、集合系统与结石的位置关系等。A组手术时间（115.1±20.4）min，明显短于B组（131.6±22.5）min（t=-2.165，P=0.039）；血红蛋白下降值（11.9±3.4）g/L，明显低于B组（14.5±2.8）g/L(t=-2.392，P=0.023)；住院时间（59±1.2）d，明显短于B组（7.1±1.5）d（t=-2.572，P=0.015）。2组均无严重并发症发生。2组术后4周一期清石率差异无显著性［93.8%（15/16） vs.87.5%(14/16),Fisher精确检验，P=1.000］。32例术后3个月复查KUB及腹部CT平扫，均未发现结石残留。结论以CT图像数据为基础的肾脏三维数字成像能够安全应用于PCNL治疗复杂肾结石，缩短手术时间，减少术中出血量。
Abstract:
ObjectiveTo explore the application value of threedimensional digital renal imaging based on CT data in the treatment of complex renal calculi by percutaneous nephrolithotomy.MethodsFrom January 2018 to December 2019, 16 cases of complicated urinary calculi were planned for surgery after threedimensional digital reconstruction based on CT data before percutaneous nephrolithotomy (group A), and 16 cases of complicated urinary calculi were planned for surgery just by CT images during the same period (group B). The operation time, blood loss, blood transfusion rate, hospital stay, complication rate, and stone removal rate 4 weeks after surgery, between the two groups were compared.ResultsAll the patients in the 2 groups were successfully treated with percutaneous nephrolithotomy. The digital imaging threedimensional model intuitively reflected the positional relationship between the main blood vessels of the kidney, the collecting system and the stones. The operation time of the group A was (115.1±20.4) min, which was significantly shorter than that of the group B ［(131.6±22.5) min; t=-2.165, P=0.039］, the hemoglobin reduction of the group A ［(11.9±3.4) g/L］ was significantly lower than that of the group B ［(14.5±2.8) g/L; t=-2.392, P=0.023］, and the total hospital stay in the group A ［(5.9±1.2) d］ was also less than that in the group B ［(7.1±1.5) d; t=-2.572, P=0015］. There were no serious complications in both groups. There was no significant difference in the stone removal rate 4 weeks after surgery between the two groups ［93.8%(15/16) vs.87.5%(14/16),Fisher’s exact test,P=1.000］.After 3 months of followups, KUB and abdominal CT scan showed no residual stones in 32 cases.ConclusionThreedimensional digital imaging of the kidney based on CT image data can be safely used in the operation of percutaneous nephrolithotomy for the treatment of complex renal calculi, which can shorten the operation time and reduce the amount of intraoperative bleeding.

参考文献/References:

[1]Zeng G, Mai Z, Xia S, et al. Prevalence of kidney stones in China: an ultrasonography based crosssectional study. BJU Int,2017,120(1): 109-116.
[2]Turk C, Petrik A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol,2016,69(3):475-482.
[3]Preminger GM, Assimos DG, Lingeman JE, et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol,2005,173(6):1991-2000.
[4]Wu C, Hua LX, Zhang JZ, et al. Comparison of renal pelvic pressure and postoperative fever incidence between standard and minitract percutaneous nephrolithotomy. Kaohsiung J Med Sci,2017,33(1):36-43.
[5]Ukimura O, Nakamoto M, Gill IS. Threedimensional reconstruction of renovasculartumor anatomy to facilitate zeroischemia partial nephrectomy. Eur Urol,2012,61(1):211-217.
[6]贾晨尧,许凯,李炳坤,等.肾脏数字化三维重建模型在腹腔镜下肾肿瘤根治术中的应用.临床泌尿外科杂志,2016,31(10):890-895.
[7]Li H, Chen Y, Liu C, et al. Construction of a threedimensional model of renal stones: comprehensive planning for percutaneous nephrolithotomy and assistance in surgery. World J Urol,2013,31(6): 1587-1592.
[8]AlKohlany KM, Shokeir AA, Mosbah A, et al. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol,2005,173(2):469-473.
[9]Mishra S, Sabnis RB, Desai M. Staghorn morphometry: a new tool for clinical classification and prediction model for percutaneous nephrolithotomy monotherapy. J Endourol,2012,26(1):6-14.
[10]Lima E, Rodrigues PL, Mota P, et al. Ureteroscopyassisted Percutaneous kidney access made easy: first clinical experience with a novel navigation system using electromagnetic guidance (IDEAL stage 1) . Eur Urol,2017,72(4):610-616.
[11]Bader MJ, Gratzke C, Seitz M, et al. The “allseeing needle”: initial results of an optical puncture system confirming access in percutaneous nephrolithotomy.Eur Urol,2011,59(6):1054-1059.
[12]Chau HL, Chan HC, Li TB, et al. An innovative freehand puncture technique to reduce radiation in percutaneous nephrolithotomy using ultrasound with navigation system under magnetic field: A singlecenter experience in Hong Kong. J Endourol,2016,30(2):160-164.
[13]De La Rosette J, Assimos D, Desai M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol,2011,25(1):11-17.
[14]林海利,郑周达,杨明根,等.经皮肾镜与输尿管软镜在孤立肾结石的应用比较.中国微创外科杂志,2016,16(4):301-303,307.
[15]Rastinehad AR, Andonian S, Smith AD, et al. Management of hemorrhagic complications associated with percutaneous nephrolithotomy. J Endourol,2009,23(10):1763-1767.
[16]Richstone L, Reggio E, Ost MC, et al. First prize (tie): hemorrhage following percutaneous renal surgery: characterization of angiographic findings. J Endourol,2008,22(6):1129-1135.
[17]林方优,余伟民,叶芃,等.融合肾锥体的解剖结构.武汉大学学报(医学版),2019,40(1):33-36.
[18]谢圣陶,陈广瑜,魏乔红,等.微通道与标准通道经皮肾镜碎石术治疗马蹄肾结石疗效的比较.中国微创外科杂志,2018,18(5):412-415.
[19]Dalela D, Gupta A, Ahmed S, et al. Threedimensional synchronized multidirectional renal pyeloangiography: a new imaging concept to facilitate percutaneous nephrolithotomy in technically challenging cases. J Endourol,2009,23(12):1937-1939.

备注/Memo

备注/Memo:
基金项目：云南省重大科技专项计划（2017ZF025）**通讯作者，Email:wylmn43@163.com
更新日期/Last Update: 2021-10-11