The Study On The Clinical Application Of “Positioning Membrane” Combined Ultrasound-guided Percutaneous Nephrolithotomy For Accurate Puncture

Objective: To explore the security and validity of the clinical application of “positioning membrane” combined ultrasound-guided percutaneous nephrolithotomy(PCNL)for accurate puncture.Methods: An analysis was performed based on the data of 30 patients who underwent“membrane-sticking” combined ultrasound-guided PCNL by an experienced urologist from January2019 to November 2019.Of all the 30 patients,19 were male and 11 were female(ages ranged from14 years to 73 years)with the mean age of 51.4 years.The stone size ranged from 20 mm to 87 mm with the mean stone size of 40.2 mm.All patients underwent CT examination in the surgical position with the “membrane” sticking on the renal area on the day before the surgery.The urologist formulated the puncture track in the CT imagines and located the puncture point.Then the patients underwent PCNL guided by ultrasound and the urologist punctured the previously located point(if it could not be punctured,the urologist would choose another place to puncture guided by ultrasound during the surgery).The number of punctures which needed for establishing each percutaneous tracts,the number of percutaneous tracts,the reasons for failed puncture and the coincidence rate of the located point were recorded and analyzed.Results: All percutaneous tubes were established and surgeries were successful.Of all the 52 punctures,41 punctures succeeded and 41 surgery tracts were established.The total success puncture rate was 78.8%(41/52).Of the total successful punctures,73.2%(30/41)succeeded at the first puncture and 26.8%(11/41)succeeded at the second puncture.Each channel needed 1.3 punctures in average.11 punctures failed: 5 punctures failed without seeing the urine after the core needle was removed;4 punctures failed because of the puncture tract deviation;2 punctures failed to display on the ultrasound imagine.The coincidence rate of the located point was 82.7%(43/52).9 punctures were done through the alternative place instead of the previous located point: 6 of them were done because of the more suitable puncture tract found by ultrasound during the surgery;2 of them were done because the previously formulated puncture tracks were too close to the inferior border of liver;One of them were done because the former puncture through the located point was failed.There were statistical differences when compared to our first stage of study with the success puncture rate of 62.7%(74/118)(p=0.038).7 patients had complications classified as Grade I,including 2 patients with a fever(patients’ temperature≥38.0℃),2 patients with postoperative pain,3 patients with renal subcapsular hematoma.One patient had complications classified as Grade II who had a fever(patient’s temperature≥38.0℃)and was cured by upgraded antibiotics.Conclusions: The clinical application of “membrane-sticking” combined ultrasound-guided PCNL with a better puncture success rate is safe and effective.