Application Of Real-time Low-dose CT Localization Guided Puncture Technique In Percutaneous Nephroscopy For The Treatment Of Complex Upper Urinary Calculi

Objective:To evaluate the clinical application value of real-time low-dose CT localization guided puncture technique in percutaneous nephrolithotripsy for the treatment of complex upper urinary calculi.Methods: A total of 40 patients with complicated upper urinary calculi undergoing surgical treatment in the Department of Urology,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2022 to December 2022 were collected.A randomized controlled clinical study was used to randomly group 40 patients meeting the inclusion criteria,according to 1: The ratio of 1 to 1 was divided into observation group and control group,with 20 patients in each group.Under the condition of operation by the same operator,observation group was given real-time low-dose CT positioning puncture to establish percutaneous renal channel and then lithotripsia.The control group was given B-ultrasound localization puncture to establish percutaneous renal channel,and then lithotripsia was performed.The primary stone clearance rate,operation time,intraoperative blood loss,secondary operation rate,hospital stay and complication rate were compared between the two groups.Results: All patients were able to successfully establish percutaneous renal working channels.In the observation group,17 patients underwent single channel lithotomy,and 3 patients underwent double channel lithotomy,with a total of 23 working channels established.1 patient was displaced during the process of being transported from CT room to operating room,and the other patient experienced fistula dissolving and channel loss during channel dilation.Both cases were successfully penetrated into the collection system along the original puncture point under the guidance of B-ultrasound according to the puncture Angle and depth provided by CT.Postoperative fever occurred in 2patients,with a peak value of 38.0 ～ 38.5℃.After anti-infection,antipyretic and fluid rehydration treatments,the body temperature returned to normal.In the control group,15 patients received single channel lithotomy,4 patients received double channel lithotomy,and 1 patient received three channel lithotomy.A total of 26 working channels were established.Postoperative fever occurred in 3 patients with a peak value of 38.5 ～ 38.8℃,and after anti-infection,antipyretic and fluid rehydration treatments,the body temperature dropped to normal.After anti-infection and other symptomatic treatment,the symptoms improved significantly.The first-stage stones of 7patients could not be completely removed,among which 3 patients had postoperative residual stones < 4mm,which were meaningless stones and were not treated,and 4 patients had postoperative residual stones > 4mm.After communication,all agreed to undergo second-stage surgery to treat residual stones.Statistical analysis showed that the first-stage stone clearance rate in the observation group was higher than that in the control group,and the amount of intraoperative bleeding was less.Operation time and hospital stay were shorter than control group(P < 0.05),the difference was statistically significant;on the contrary,the second stage operation rate and complication rate were similar,the difference was not statistically significant(P > 0.05).Conclusion(s):1.Percutaneous nephrolithotripsy is currently the main clinical method for the treatment of complex upper urinary tract calculi.The success rate of percutaneous nephrolithotripsy is not satisfactory with the traditional puncture guide used to establish working channels in percutaneous nephrolithotripsy.2.Real-time low-dose CT positioning guided puncture can provide more accurate positioning for the establishment of PCNL operating working channel and improve the stone clearance rate of percutaneous nephrolithotripsy in the treatment of complex upper urinary tract calculi.