Application of preoperative low-dose CT pre-positioning and intraoperative B-ultrasound correction localization-guided puncture technique in percutaneous nephrolithotomy

doi:10.3877/cma.j.issn.1674-3253.2023.03.005

Abstract

Abstract:

Objective

To investigate the safety and efficacy of preoperative low-dose CT pre-positioning in the CT room, combined with intraoperative real-time B-ultrasound correction positioning-guided puncture for percutaneous nephrolithotomy (PCNL) in the treatment of complex renal calculi.

Methods

From August 2020 to August 2022, 82 patients diagnosed with complicated nephrolithiasis requiring PCNL were selected and divided into observation group and control group according to the principle of randomized control, with 41 cases in each group, and the observation group was subjected to low-dose CT scan in the CT room before surgery, and the CT scan results were transmitted to the spiral CT workstation for three-dimensional reconstruction. According to the target renal calyces, the puncture site was obtained from the cross-section of the CT and the depth and angle of the needle were measured. The data provided by CT were guided to pre-mark the puncture point on the patient's body, and the predetermined puncture point and path were corrected and positioned under B-ultrasound monitoring during the operation, and the working channel was accurately established and the PCNL was performed. The control group underwent B-ultrasound-guided positioning to establish the puncture channel and performed PCNL, and the relevant data such as the success rate of calycesis, the time of lithotripsy, intraoperative blood loss, primary stone clearance, and postoperative complications were compared between the two groups.

Results

The success rate of target calyceal puncture and the first-stage stone clearance rate in the observation group were higher than those in the control group, while the lithotripsy time and intraoperative blood loss were both less than those in the control group, and the differences were statistically significant.

Conclusions

Preoperative low-dose CT pre-positioning and intraoperative B-ultrasound correction positioning-guided puncture technology can improve the success rate of target calyx puncture and stone clearance rate for complex kidney stones, shorten the time of lithotripsy, and reduce blood loss. It has good application value in the treatment of complex renal calculi.

Key words: CT pre-positioning, Intraoperative untrasound positioning, PCNL, Renal calculi

Xin Wang, Zhibiao Qin, Sihua Chen, Jiazhou Zhang, Gewen Bi, Hua Lei, Qiguang Li. Application of preoperative low-dose CT pre-positioning and intraoperative B-ultrasound correction localization-guided puncture technique in percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 223-227.

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References 19

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组别	例数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾实质厚度[cm，(±s)]	肾盂分离[cm，(±s)]	结石CT值[Hu，(±s)]	术前血清肌酐[μmol/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾实质厚度[cm，(±s)]	肾盂分离[cm，(±s)]	结石CT值[Hu，(±s)]	术前血清肌酐[μmol/L，(±s)]
观察组	41	31	10	50±10	26±3	2.7±0.6	1.4±0.7	2.3±0.8	1 028±216	68±32
对照组	40	26	14	54±9	25±3	2.6±0.6	1.5±0.7	2.3±0.7	940±242	67±29
统计值		χ²=1.093		t=-1.753	t=0.827	t=1.046	t=-0.118	t=0.304	t=1.717	t=0.144
P值		0.296		0.084	0.411	0.299	0.907	0.762	0.09	0.886

组别	例数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾实质厚度[cm，(±s)]	肾盂分离[cm，(±s)]	结石CT值[Hu，(±s)]	术前血清肌酐[μmol/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	结石最大径[cm，(±s)]	肾实质厚度[cm，(±s)]	肾盂分离[cm，(±s)]	结石CT值[Hu，(±s)]	术前血清肌酐[μmol/L，(±s)]
观察组	41	31	10	50±10	26±3	2.7±0.6	1.4±0.7	2.3±0.8	1 028±216	68±32
对照组	40	26	14	54±9	25±3	2.6±0.6	1.5±0.7	2.3±0.7	940±242	67±29
统计值		χ²=1.093		t=-1.753	t=0.827	t=1.046	t=-0.118	t=0.304	t=1.717	t=0.144
P值		0.296		0.084	0.411	0.299	0.907	0.762	0.09	0.886

组别	例数	一期结石清除率(%)	目标肾盏一次穿刺成功率(%)	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后发热(例)	肾迟发性出血(例)
观察组	41	87.8	90.2	84±12	40±22	7	0
对照组	40	70.0	70.0	98±18	57±41	8	1
统计值		χ²=3.871	χ²=4.035	t=-4.288	t=-2.341	χ²=0.115	-
P值		0.049	0.045	<0.001	0.022	0.735	0.494

组别	例数	一期结石清除率(%)	目标肾盏一次穿刺成功率(%)	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后发热(例)	肾迟发性出血(例)
观察组	41	87.8	90.2	84±12	40±22	7	0
对照组	40	70.0	70.0	98±18	57±41	8	1
统计值		χ²=3.871	χ²=4.035	t=-4.288	t=-2.341	χ²=0.115	-
P值		0.049	0.045	<0.001	0.022	0.735	0.494

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