杨守东 张卫星 卢浩彬 刘广科 段晴光

【摘要】 目的：分析平掃CT进行三维重建定位穿刺点在经皮肾镜碎石取石术（PCNL）治疗复杂性肾结石手术中的应用效果。方法：选定本院2016年1月-2020年1月收治的88例复杂性肾结石患者。以双盲随机抽样法分组，对照组和观察组各44例。对照组采用B超定位下微创经皮肾镜钬激光碎石术治疗，观察组平扫CT三维重建定位穿刺PCNL手术治疗。对比两组临床指标、结石清除率、血清炎性因子水平、并发症发生率、GQOL-74评分。结果：观察组手术时间、首次下床时间及住院时间均显著短于对照组，术中出血量显著低于对照组（P<0.05）。观察组结石清除率为97.73%，显著高于对照组的84.09%（P<0.05）。术后3 d，观察组的血清PCT、hs-CRP、IL-1β水平均显著低于对照组（P<0.05）。观察组并发症发生率4.55%显著低于对照组的20.45%，差异有统计学意义（P<0.05）。术后3个月，观察组GQOL-74的各项评分均明显高于对照组（P<0.05）。结论：平扫CT三维重建定位穿刺PCNL手术可有效缩短复杂性肾结石患者手术时间，提高结石清除率，减轻炎症反应，改善生活质量，且术后并发症较少，值得借鉴。

【关键词】 平扫CT 三维重建定位穿刺点 经皮肾镜碎石取石术 复杂性肾结石 生活质量

The Effect of Plain CT Three-dimensional Reconstruction and Localization of Puncture Site in the Treatment of Complicated Renal Calculi with PCNL/YANG Shoudong， ZHANG Weixing， LU Haobin， LIU Guangke， DUAN Qingguang. //Medical Innovation of China， 2021， 18（07）： -149

[Abstract] Objective： To analyze the effect of plain CT three-dimensional reconstruction and localization of puncture point in percutaneous nephrolithotripsy （PCNL） for the treatment of complicated renal calculi. Method： A total of 88 patients with complicated renal calculi admitted to our hospital from January 2016 to January 2020 were selected. They were grouped by double-blind random sampling， control group and observation group each had 44 cases. The control group was treated with minimally invasive percutaneous holmium laser lithotripsy under B-ultrasound localization， and the observation group was treated with plain CT three-dimensional reconstruction localization puncture PCNL surgery. Clinical indicators， stone clearance rate， serum inflammatory factor level， complication rate and GQOL-74 score were compared between the two groups. Result： The operation time， the first time of getting out of bed and the hospital stay in the observation group were significantly shorter than those in the control group， and the intraoperative blood loss was significantly lower than that in the control group （P<0.05）. The stone clearance rate of observation group was 97.73%， which was significantly higher than 84.09% of control group （P<0.05）. On day 3 after operation， the levels of serum PCT， hs-CRP and IL-1β in the observation group were significantly lower than those in the control group （P<0.05）. The incidence of complications in the observation group was 4.55%， significantly lower than 20.45% in the control group， the difference was statistically significant （P<0.05）. Three months after operation， the scores of GQOL-74 in the observation group were significantly higher than those in the control group （P<0.05）. Conclusion： Plain scan CT three-dimensional reconstruction localization puncture PCNL surgery can effectively shorten the operation time of patients with complicated renal calculi， improve stone clearance rate， reduce inflammatory reaction， improve the quality of life， and fewer postoperative complications， which is worthy of reference.

[Key words] Plain CT Three-dimensional reconstruction to locate the puncture point Percutaneous nephrolithotomy Complex renal calculi Quality of life

First-authors address： Chashan Hospital of Dongguan， Dongguan 523382， China

doi：10.3969/j.issn.1674-4985.2021.07.035

复杂性肾结石是一种临床较为常见、难治的泌尿系结石之一，具有较高的发病率，近年来，随着我国人们生活方式、环境、饮食结构变化，复杂性肾结石的发生率明显增高[1-2]。传统肾切开取石术创伤性较大，术后机体炎症反应较重，容易出现感染等并发症，一定程度上延长了患者的恢复时间，综合治疗效果欠佳[3-4]。平扫CT进行三维重建定位可提供结石、肾盏分支、大小以及形状等，发现阴性结石，具有超声等不可替代的作用。基于此，本研究选定本院2016年1月-2020年1月收治的88例复杂性肾结石患者进行探讨，现报道如下。

1 资料与方法

1.1 一般资料 选定本院2016年1月-2020年1月收治的88例复杂性肾结石患者。（1）纳入标准：①均经CT、超声等检查确诊，存在不同程度血尿、肾区叩击痛等症状;②尿检可见晶体尿、血尿等;③年龄在18周岁以上;④临床资料齐全、意识清醒。……