Clinical Application Research Of Three-dimensional CT Reconstruction In PCNL Guiding Puncture Target Calyx

Objective:To investigate the utility of three-dimensional CT reconstruction for pinpointing target calyx, preoperative planning of puncture track,guiding puncture target calyx in percutaneous nephrolithotomy.Methods:From September2013to May2014,80patients with renal or ureteral calculi who required to be treated with PCNL were selected in our department, they were randomly divided into the experimental group and control group,40cases in each group. The experimental group was given CTU and three-dimensional reconstruction for preoperative diagnosis and assessment of stone, design of the puncture track for the purpose of guiding intraoperative puncture. The control group underwent plain film of kidney-ureter-bladder (KUB) and intravenous urography (1VU) or retrograde pyelogram(RPG) to get diagnosis and guide the intraoperative puncture. The rate of stone detection, puncture time, operation time, number of puncture channels, intraoperative blood loss, success rate of once puncture, rate of stone clearance, rate of complications were compared between the two groups.Results:The procedures were completed successfully in both the groups, no death case was recorded. The rate of stone detection in experimental group (CTU) was100%. puncture time was6±1.2min, operation time was101±31.2min, number of puncture channels was1.2±0.2, intraoperative blood loss (decrease of postoperative hemoglobin)was18±5.1g/L. success rate of once puncture was82.5%. rate of stone clearance was87.5%; However, the rate of stone detection in control group (IVU) was95%. puncture time was9±2.7min, operation time was112±27.3min. number of puncture channels was1.3±0.4, intraoperative blood loss (decrease of postoperative hemoglobin)was33±8.4g/L, success rate of once puncture was62.5%, rate of stone clearance was67.5%. No significant difference was detected in the rate of stone detection, operation time, number of puncture channels; Compared to the control group, the experimental group showed shorter puncture time, less intraoperative blood loss, higher success rate of once puncture and rate of stone clearance, the difference was statistically significant. The experimental group had no severe complications such as bleeding, peripheral viscera injuries; In the control group, one patient’s colon was injured, the injury of colon occurred in one case of control group, the patient was cured and discharged through conservative management with placement of colon drainage tube and Total Parenteral Nutrition.Conclusion:Three-dimensional CT reconstruction can be used to do a full preoperative assessment, plan for an optimal puncture track. Preoperative planning for PCNL with three-dimensional CT reconstruction have a significant impact on guiding puncture target calyx, resulting in a higher precision of puncture and rate of stone clearance, less intraoperative blood loss, and lower rate of complications.