| Objective(s):To investigate the clinical efficacy and value of using CT 3D reconstruction preoperatively to select the target calyces,and to scientifically design the surgical channel to guide the intraoperative precision establishment of the surgical channel for PCNL.Methods: A prospective study was conducted on 153 patients with kidney and upper ureteral calculi admitted to the Department of Urology of Hospital A,Hospital B,Hospital C,hospital D and Hospital E from November 2021 to November 2022.The CT image post-processing system was used to perform three-dimensional imaging of the stone and renal collecting system on the thin-slice CT images of the subjects.The distribution of the stone in the renal collecting system was analyzed,and the posterior or posterolateral calyx that could cover the maximum extent of the stone was selected as the target calyx.During the operation,under the guidance of C-arm X-ray,the target renal calyx was accurately puncted according to the preoperative designed surgical path,and the surgical channel was established to complete PCNL.The preoperative,intraoperative and postoperative data of all patients were collected and statistically analyzed.The safety and effectiveness of this method were discussed according to the literature.Results: A total of 155 affected kidneys from 153 patients were included in this study,all of whom successfully established PCNL access and completed the operation under the preoperative design followed by C-arm X-ray guidance,and there were no patients who died perioperatively.Of all patients,52(33.55%)were multiple calyceal stones,38(24.51%)were staghorn stones,29(18.71%)were renal pelvic stones,30(19.35%)were upper ureteral stones,and the remaining 6(3.87%)had single calyceal stones.A total of 169 surgical passes for PCNL were established in 153 patients,and the mean operative time was 63.28 ± 32.17min(range,20-150min).All patients showed a mean hemoglobin drop of 12.27 ± 12.12(0-54)g / L.Of all patients,a total of 60(39.22%)experienced complications,of which 55(35.95%)patients developed grade I complications according to the Clavien Dindo complication grading system,all were transient pain or fever except one case of pleural injury resulting in a small amount of pleural effusion.Grade II complications occurred in 2(1.31%)patients,all of whom were transfused.Grade IV complications occurred in 3(1.96%)patients,all of whom were septic shock.There were no patients with grade III and V complications.There were 122 patients(78.71%)who had their stones cleared after one session of PCNL,and the remaining 20 patients had undergone adjuvant treatments(secondary PCNL,extracorporeal shock wave lithotripsy,retrograde intrarenal surgery).Ultimately all patients had a stone free rate of 87.10%,including the stone free rate of 100% for single calyceal stones,96.55% for renal pelvic stones,80.77% for multiple calyceal stones,78.95% for staghorn stones,and 100% for upper ureteral stones.Conclusion(s): 1.PCNL using CT 3D reconstruction assistance and X-ray guidance can effectively improve the success rate and stone free rate of the surgery,reduce the complications of PCNL,and especially avoid the occurrence of serious complications in the kidneys and adjacent organs.2.Using CT 3D reconstruction images for planning PCNL access can effectively reduce the number of accesses and shorten the learning curve of the surgery.3.The method of CT 3D reconstruction assisted with precise establishment of PCNL access is standardized,safe and easy to operate,and suitable for wide implementation in primary hospitals. |
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