阳光 张玉龙 瞿根义 向茂林 汤乘 王佳威 徐勇

摘要：目的：對比研究术中CT-B超融合成像与常规超声定位下经皮肾镜取石手术治疗肾结石的疗效与安全性。方法：前瞻性收集我院2018年1月至2019年1月行经皮肾镜取石术治疗肾结石患者的临床资料，采用随机数字表法分组，分为CT-B超组和B超组。总结两组患者的目标盏定位时间、手术时间、结石清除率、术后血红蛋白下降值、住院时间和并发症发生率。结果：本研究共纳入122例患者。其中CT-B超组60例，B超组62例。术前两组患者在性别、年龄、结石长径、体重指数方面的差异均无统计学意义（P>0.05）;CT-B超组和B超组目标盏定位时间[（40.6±17.7）S与（50.5±19.8）S]、手术时间[（43.1±15.9）min与（52.2±15.0）min]、术后发热率（5.0%和17.7%）的比较差异均有统计学意义（P<0.05）。CT-B超组和B超组一期结石清除率（91.7%和88.7%）、术后血红蛋白下降值[（9.5±6.4）g/L与（10.1±5.6）g/L]及住院时间[（7.0±2.2）天与（7.7±2.7）g/L]比较差异均无统计学意义（P>0.05）。结论：采用CT-B超融合成像技术在实时超声定位下行经皮肾镜取石术治疗肾结石，可以缩短患者目标盏定位时间及手术时间，同时减少手术并发症，值得临床推广使用。

关键词：融合成像技术;经皮肾镜取石术;结石;超声

【中图分类号】R730.41 【文献标识码】A 【文章编号】2107-2306（2020）01-015-02

【Abstract】Objective： Comparative Research on CT During Surgery - The efficacy and safety of percutaneous nephrolithotomy under ultrasound fusion imaging in real-time ultrasound positioning and conventional ultrasound positioning for treating renal calculi. Method： Prospectively collected clinical materials from January 2018 to January 2019 on kidney calculi patients who had undergone percutaneous nephrolithotomy at this hospital， adopted random number chart method to divide them into CT-B ultrasound and B ultrasound groups. Summarized these two groups’ patients’ target calyx positioning time， surgery time， renal stone clearance rate， postoperative hemoglobin rate decrease， hospitalization time and complication rate. Results： This research comprised a total of 122 patients， including 60 in CT-B ultrasound group and 62 in B ultrasound group. Before surgery， the difference between the two groups’ aspects of gender， age， kidney stone length-diameter， and body mass index were not statistically significant （P>0.05）; Difference between CT-B ultrasound group and B ultrasound group’s target calyx positioning time [（40.6±17.7）S and （50.5±19.8）S]， surgery time [（43.1±15.9）min and （52.2±15.0）min]， and rate of postoperative fever （5.0% and 17.7%） was statistically significant （P<0.05）. Difference between CT-B ultrasound group and B ultrasound group’s one-stage stone clearance rate （91.7% and 88.7%）， postoperative hemoglobin rate decrease [9.5±6.4）g/L and （10.1±5.6）g/L] and hospitalization time [（7.0±2.2） days and （7.7±2.7）g/L] was not statistically significant （P>0.05）.

Conclusion： Adopting percutaneous nephrolithotomy under CT-ultrasound fusion imaging technology in real-time ultrasound positioning to treat renal calculi can reduce patients’ target calyx positioning time， reducing surgery time， while also reducing surgery complications. It is worth promoting for widespread clinical use.

【Key words】Image-fusion technique;percutaneous nephrolithotomy;calculus;Ultrasound;

我国泌尿系结石的发病率为6.50%，南方地区高达8.85%，且发病率呈上升趋势[1]。对于较大的或复杂性泌尿系结石，经皮肾镜取石术（PCNL）是最主要的手术方法，而建立理想的穿刺通道是PCNL手术成功的关键，可以最大程度上清除结石，从而达到最佳的治疗效果[2]。CT-超声融合成像定位是一种新技术，将实时超聲图像与CT图像进行配准即可实现两种图像的同步、融合显示，又整合了超声与CT两种影像信息。……