The Clinical Research Of Constructing Safely PNL Pathway Under The 2D (2-dimensional)CT Reconstruction

【Objective】To investigate the clinical value of constructing PNL pathway using the 2D(2-dimensional) CT reconstruction to image the kidney and nearby organs.【Methods】80 upper ureter calculus patients were collected from 2008/01 to 2008/12, and were adopted double kidney 2D CT examination through prone position and raised the abdomen diaphragmatic muscle and double kidney CT plain and enhancement scanning before the surgery.To observe the double kidney anteroposterior axes and oblique 2D reconstruction at the end of aspiration and expiration ending,it was used to determine the positive relationship of pleura inferior margin and intercostals,and check the PNL pathway arounding whether exist any organs.【Results】80 upper ureter calculus patients using double kidneys CT plain and reconstruction after statistics data analysis shows that punctured in the tenth rib,the pleura existed on the oblique aspiration ending and expiration ending,the pleura injured possibility is 100%.the liver wound possibility is 32.5%and the spleen wound possibility is 36.25%.Punctured in the eleven rib:the pleura injured possibility are the left side 18(22.5%) and the right side 22(27.5%),in the left and right renal oblique at the end aspiration,the pleura injured are the left side 8(10%) and the right side 14(27.5) in the left and right renal oblique at the end expiration,64(80%) and 70(87.5) in the anteroposterior axes at the aspiration end,48(60%) and 66(82.5) in the anteroposterior on the expiration,that can show a conclusion that punctured in the eleven rib PNL pathway,the pleura in the oblique was lower than the anteroposterior at the aspiration and expiration end.The liver wound possibility is 1.25%and the spleen wound possibility is 3.75%in the renal oblique at the expiration end. Punctured upperl cm in the twelve rib below PNL pathwa:there is no pleura inferior margin in the left renal oblique position at the aspiration and expiration end,the right pleura injured possibility is 2(2.5%) in the left oblique position at the aspiration and expiration end.No liver and spleen injured in the left and right renal oblique position using this puntrued PNL pathway.The pleura injured possibility is 6(7.5%) in the anteroposterior on the left and right in aspiration end and the pleura injured possibility are 4(5%) and 2(5%) in the anteroposterior at the expiration end,and also can not injure the liver and the spleen.When punctured lower 1 cm in the twelve rib below, no liver and spleen and pleura inferior margin existed,at the end of expiration and aspiration.In this research,under the 2D reconstructed before the surgery,77 patients were safely constructed PNL pathway and successfully moved the calculus,the rate was 89%.Among 97 PNL pathway constructed cases we have done,41 cases through in the eleventh rib,56 cases through the twelve rib,5 cases were two PNL pathway.Postoperative chest X-ray and chest CT plain scanning tanken showed the proposed pathway no pleural and abdominal injuried,2 cases of upper ureteral calculus after the reconstruction image showed the calculus located below the costo-phrenic angle at the twelfth rib in order to avoid the pleural injury deciding to operate the ureteroscopic lithotripsy surgery.1 cases of kidney calculus found in patients with renal CT plain scanning after the two-dimensional reconstruction showed the colon and the costo-phrenic angle,it changed to deal with open surgery.[Conclusions]The 2D(2-dimensional) CT reconstruction imaging can clearly show costo-phrenic angle location in different intercostals and the adjacent relation about kidney and nearby organs,correctly guide to establish PNL pathway,and can effectually avoid the pleura injured and belly cavity organs injured.Adopt expiration end axillary location to establish skin to kidney pathway injure of the pleura and belly cavity organs as follow:punctured in the tenth rib,the pleura wound possibility is 100%.the liver wound possibility is 32.5%;the spleen wound possibility is 36.25%.punctured in the eleventh rib,the right pleura injured possibility is17.5% both on the oblique aspiration ending,the left pleura injured possibility is 10%,the liver wound possibility is 1.25%,the spleen wound possibility is 3.75%.Punctured under in the twelfth rib,no the pleura inferior margin in the left renal oblique position on the aspiration and expiration end,the right pleura wound possibility is2.5%,no the liver and the spleen in the left and right renal oblique position on the aspiration and expiration end puntrued in this pathway.