CT尿路造影及三维重建在微创经皮肾镜取石术中应用.doc

CT尿路造影及三维重建在微创经皮肾镜取石术中应用 　 作者：张鸽，孙利国，张杰，马俊，陈永昌，孙颖，缪瑜 【摘要】 　　目的：探讨CT尿路造影（computed tomography urography, CTU）及三维重建在微创经皮肾镜取石术（mini-percutaneous nephrolithotomy, MPCNL）中的应用价值。方法：我院自 2007年1月~2008年2月对16例上尿路结石患者术前行多层螺旋CT尿路造影, 将获得的影像数据进行三维重建,以指导选择最佳穿刺径路。结果：CTU及三维重建可提供清晰的肾盂肾盏、输尿管的形态结构,可明确结石在肾脏、输尿管的空间定位,有利于确定经皮肾穿刺的部位。全部患者经单通道行MPCNL术获成功, 结石总取净率93.74%，无严重并发症发生。结论：CTU及三维重建有助于术前规划穿刺点、穿刺方向，术中理解B超定位、穿刺时动态的、二维的影像，对MPCNL穿刺定位具有指导意义，对提高手术成功率、减少并发症具有重要意义。 【关键词】 尿石症 CT尿路造影 三维重建 微创经皮肾镜取石术 　　[Abstact] Objective：To study the value of multidetector computed tomography urography(CTU) and three-dimensional reconstruction in mini-percutaneous nephrolithotomy(MPCNL). Methods: Sixteen patients with renal and ureteral calculi underwent CTU from Jan. 2007 to Feb. 2008. Data were analysed and three-dimensional reconstruction was performed in order to choose an optimal percutaneous approach into the pelvicalyceal system (PCS) before MPCNL. Results: CTU provided a clear view of the PCS, with stones detected in all patients and their relation with the PCS determined accurately. Three-dimensional reconstructed images had the advantage of optimizing percutaneous approach into the PCS. All the cases were punctured successfully, and the total stone-free rate reached 93.74% with no serious complications. Conclusions: CTU and three-dimensional reconstruction were enable to predict the number, size and site of stones in pelvicalyceal system accurately and confidently, and their reproduction, optimal site for placing the percutaneous track, and potential hazards when placing the track. CTU and three-dimensional reconstruction should become an imaging method for planning MPCNL in patients with complicated calculi. 　　[Key words] Renal and ureteral calculi; Computed tomography urography; Three-dimensional reconstruction, Mini-percutaneous nephrolithotomy 　　尿石症是泌尿外科常见的疾病之一，发病率高,复发率高[1]。微创经皮肾镜取石术（mini-percutaneous nephrolithotomy, MPCNL）已逐渐取代传统的开放手术治疗复杂肾结石。2007年1月~2008年2月我院应用多层螺旋CT尿路造影（computed tomography urograph