Clinical Research Of CT Urography Guiding Accurate Pinpointing The PCNL Target Calyx

[Objective]:To study the application value of computed tomography urography(CTU) in guiding accurate pinpointing the PCNL target calyx.And we obtained the clinical value of CTU in PCNL for renal calculi.[Methods]:In July2011-March2013, we selected150patients who were diagnosed with renal calculi and required to be treated with PCNL in patients in the department of minimally invasive urology the Second Affiliated Hospital of Kunming Medical University. There are121cases of male and29patients were female. The oldest was71years old, the youngest is21years old. All patients were diagnosed with renal calculi having the imaging evidence, and they also meet the inclusion and exclusion standard.These patients were then randomly divided into each of the75patients of the experimental group and the control group.The experimental group patients were performed CT urography.The control group are not dealing with CT urography. All patients underwent PCNL operations routinely under general anesthesia. Preoperatively, we recorded two groups of patients with general information, including age, weight, height, size, Complex renal calculi and duration of the disease. After operation,We get each patient data, including operation time, free stone rates,postoperative hospitalization days, haemorrhage and blood transfusion. The data was performed by statistical analysis.[Results]:We compared the experimental group and control group by statistical methods.The Stone size, duration of the disease, age,BMI,the number of patients with functional single kidney were not statistically significant.149patients’ operation were successfully completed. In the control group, One patient’s operation was stoped because of the intraoperative expansion Serious bleeding.After liening renal fistula, two-stage operation was completed..there was no death and renal failure cases. In the experimental group and control group, the free stone rate was64/75(83.5%) and54/75(72%)(P<0.05). The free stone rate of Complex renal calculi was20(68.96%) and11(45.83%)(P<0.05).The number of post-operative blood transfusion were0and4(P<0.05).The number of patients who postoperative hemoglobin decreased more than30%compared with the preoperative hemoglobin was2and9(P<0.05).the mean operation time were83.08±28.04min and92.94±28.50min(P<0.05). The above data were statistically significant.But The difference was not significant in The Mean postoperative hospital stay days and postoperative hematuria. The Mean postoperative hospital stay days were6.64±2.66and7.00±2.73. The number of patients with intraoperative expansion Serious bleeding were0and1.The number of patients postoperative hematuria which lasted for24hours or more were3and9(P>0.05).[Conclusion]:CT urography can clearly show of the anatomical morphology of the renal pelvis and stones, including the relationship between the stones and pyelocalicial. For the patient who was diagnosised of renal calculi and required to be treated with PCNL,it can accurately determine the optimal operative renal calyx. CT urography can accuratly selects the best target calyx and can guide puncture and provides guidance for establishing a channel. Thereby,it can improve free stone rate, reduce the rate of postoperative blood transfusion,the operative time and reduce bleeding-related complication.Intraoperative under the C arm X-ray monitoring. This technique contribute to operation effectiveness and is worth to be used widely in clinical practice.