| Objective: Explore the process to mimic the puncture by means of the preoperative CT, establish the targeted calyx, preliminary build the puncture pathway, and study the safety and efficacy of percutaneous nephroscope(PCNL) technique with intraoperative real-time colour Doppler ultrasound to go through the same puncture point for puncturing the targeted calyx.Methods: A retrospective analysis and comparisons on pathway length, puncture time consumption and etc. in terms of the mimic puncture with the preoperative CT and percutaneous nephroscopecolour(PCNL) with intraoperative real-time colour Doppler ultrasound for the patients with kidney stones were performed in uropoiesis surgical department at our hospital from January 2013 to December 2014. Inclusion criteria: the patients with the kidney stones were suitable for such treatment as to establish a single channel. Such kidneys, including 180 cases, were with shallow renal calyx and with or without water. All these cases were performed preoperative KUB + IVU, among which 56 cases were puncture by the guidance of the pure colour Doppler ultrasound; 124 cases were performed the mimic puncture with the preoperative CT and intraoperative positioning puncture with real-time colour Doppler ultrasound. The group of cases where the PCNL technique with pure colour Doppler ultrasand is group A; while the group of cases where the PCNL with preoperative CT mimic puncture and intraoperative real-time colour Doppler ultrasound is group B. The puncture point for preoperative CT mimic puncture or simulation skin puncture point or intraoperative is the junction point of the bottom of the 12 th rib and the axillary line. The target calyx was set in the process of inspiratory phase. setting goals after puncture for the calyx of the group under the lamp that vault and light after light fornix, inspiratory phase when the puncture path length measurement. The length of puncture path was measured in the process of inhale phaseduring inspiration. From the corresponding target calyces fornix, the same puncture point was used in intraoperative real-time B-ultrasound in the inhale phase of an inspiratory. The time of the channel establishment, the length of puncture path, the operation time, the amount of the blood loss and the stone clearance rate were compared and analyzed in these two methods in terms of positioning the puncture point. Statistical approach employed the tool of SPSS19.0 and the four-grid table method, counting by x ±SD.Results: The time for establishing channels and operating in theater in group B were significantly less than that in group A(3.8 + 1.2 minutes vs 5.3+ 1.6 minutes and 56.3 + 28.5minutes vs 76.3 + 34.2 minutes, p < 0.05). The decrease in hemoglobin in group B was lower than that in group A(16.4 + 6.3g/l vs 25.8 + 7.5 g/l, p < 0.05).In group A, two cases bled in the course of operation and two cases bled afterwards. The DSA embolization was executed after failure conservative treatments. In group B, one case with scoliosis was transfused and no embolism case was reported. The stone clearance rate in group B was obviously higher than that in group A,(97.3+/-3.7% vs 96.7+/-3.9%), p > 0.05, although the discrepancies are meaningless for statistics. The mimic puncture with Preoperative CT was 60 cases, and the puncture path length was 6.0 + /- 0.4 cm, and the path length in intraoperative real-time puncture lights with the colour Doppler utltrasound was 7.2 + /- 0.5 cm. However, this discrepancy was meaningful to statistics. There were 64 cases for mimic puncture under light with preoperative CT and the path length was 5.0 + /- 0.4 cm. The path length for intraoperative real-time puncture under light with colour Doppler ultrasound was 6.3 + /- 0.5 cm. The discrepancy is meaningful for statistics.Conclusions: The preoperative CT determined the target calyx and the mimic puncture, planed the puncture path, decreased the amount of blood loss, saving both puncture and operation time. The intraoperative real-time B-ultrasound positioned the target calyx being punctured through the same skin puncture point, and could adjust the error incurred by the CT puncture path from position changes. |
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