目的 探究CT-超声影像融合(融合超声)引导下肾盏穹隆精准穿刺在轻度积水肾结石经皮肾镜取石术(PCNL)中的临床应用。方法 回顾性分析2024-04至2026-02在武警安徽总队医院泌尿外科行PCNL治疗的88例轻度积水肾结石患者的临床资料,依据穿刺引导方式不同分为融合超声组(n=40)和对照组(n=48)。融合超声组采用 CT-超声影像融合技术定位肾盏穹隆行精准穿刺建立经皮肾通道;对照组采用常规二维超声,术者依靠临床经验完成穿刺。对比两组穿刺针数、通道建立时间、手术时长、术中出血量、一期清石率、术后住院时间、术后血红蛋白和血肌酐水平及并发症发生情况。结果 融合超声组穿刺针数、通道建立用时、手术时长、术中出血量、术后住院时间均低于对照组;融合超声组术后血红蛋白水平明显高于对照组,差异均有统计学意义(P＜0.05),两组血肌酐水平差异无统计学意义;融合超声组一期清石率87.50%,显著高于对照组的68.75%;融合超声组术后并发症发生率7.50%,明显低于对照组22.91%,以上对比差异均有统计学意义(P＜0.05)。结论 CT-超声影像融合辅助肾盏穹隆靶向穿刺用于轻度积水肾结石 PCNL,可提升穿刺成功率与一期清石率,缩短手术及住院时间,减少术中出血与术后并发症,手术整体安全性与有效性较高。
Abstract
Objective To investigate the clinical application of CT-ultrasound image fusion (fusion ultrasound)-guided precise puncture of renal calyx dome in percutaneous nephrolithotomy (PCNL) for patients with mild hydronephrosis and renal calculi. Methods A retrospective analysis was conducted on 88 patients with mild hydronephrotic renal calculi who underwent PCNL treatment at the Department of Urology of Anhui Provincial Corps Hospital of Chinese People's Armed Police Force from April 2024 to February 2026. The patients were divided into a fusion ultrasound group (n=40) and a control group (n=40) based on different puncture guidance methods. The fusion ultrasound group used CT-ultrasound image fusion technique to precisely locate and puncture the renal calyx dome to establish a percutaneous access tract, while the control group relied on conventional two-dimensional ultrasound and the experience of the operators for puncture. The number of puncture attempts, tract establishment time, surgical duration, intraoperative blood loss, primary stone clearance rate, postoperative hospitalization stay, postoperative hemoglobin and serum creatinine levels, and complication rates were compared between the two groups. Results The fusion ultrasound group showed significantly fewer puncture attempts, shorter tract establishment time, shorter surgical duration, less intraoperative bleeding, and shorter postoperative hospitalization compared to the control group. Hemoglobin levels were significantly higher in the fusion ultrasound group than in the control group (P<0.05), while there was no statistically significant difference in serum creatinine levels between the two groups. The primary stone clearance rate was 87.50% in the fusion ultrasound group, significantly higher than 68.75% in the control group (P<0.05). The postoperative complication rate was 7.50% in the fusion ultrasound group, significantly lower than 22.91% in the control group. All differences were statistically significant (P<0.05). Conclusions Targeted puncture of the renal calyx dome using CT-ultrasound image fusion in PCN for patients with mild hydronephrotic renal calculi demonstrates high overall safety and efficacy, which can effectively improve the puncture success rate and primary stone clearance rate, shorten the operation and hospitalization duration, and reduce the intraoperative bleeding and postoperative complications.
关键词
经皮肾镜取石术 /
计算机断层扫描 /
超声图像融合技术 /
肾结石 /
肾积水
Key words
percutaneous nephrolithotomy /
computed tomography /
ultrasound-image fusion technique /
renal calculi /
hydronephrosis
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参考文献
[1] Schlomer B J.Urologic treatment of nephrolithiasis[J]. Curr Opin Pediatr, 2020, 32(2):288-294.
[2] Xue S W, Zhang M B, Luo Y K, et al. A comparative study of ultrasound-guided percutaneous nephrolithotripsy and x-ray-guided percutaneous nephrolithotripsy in the treatment of complex renal calculi without hydronephrosis[J]. Pak J Med Sci, 2022, 38(8): 2259-2265.
[3] 莫智波,何书明,彭泽椿,等.微通道镜经皮肾镜碎石取石术一期治疗无积水肾结石疗效观察[J].海南医学, 2022, 33(9):1167-1169.
[4] 沈学成,沈骏超,陈 嗣,等.经皮肾镜取石术后胸膜损伤的发生情况及相关因素分析[J].武警医学, 2026, 37(2):106-109.
[5] Li W, Li K P, Shan Y, et al. Contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with a non-dilated collecting system: results of a pooled analysis of randomized controlled trials[J].BMC Urol, 2023, 23(1):93.
[6] Shen X B, Li K W, Wu Z Y, et al. A novel computed tomography-ultrasound image fusion technique for guiding the percutaneous kidney access[J]. Urol J, 2023, 20(4):208-214.
[7] Surawach P, Kun S, Yada P, et al.Fluoroscopy-free mini-PCNL using CT-ultrasound fusion guidance in a pediatric patient with recurrent cystine stones: a case report[J]. Urol Case Rep, 2026, 65:103367.
[8] 黄苏溪,海拉提,孙丙华,等.经皮肾穿刺在肾镜取石中的应用及创新[J].武警医学, 2025, 36(9):803-810.
[9] Mladen D,Jasmin G, Usman K, et al. Evolution of percutaneous nephrolithotomy (PCNL) from standard to miniaturized and ultra-mini techniques: a narrative review[J]. Medicine (Kaunas), 2026, 62(3):484.
[10] Chaojie X, Aolin L, Yiji P, et al. Conventional ultrasonography enabled with augmented reality needle guidance for percutaneous kidney access: an innovative methodologies randomized controlled trial[J]. Int J Surg, 2025, 111(1):661-676.
[11] Ali T, Bhaskar K S. Utility of augmented reality in endoscopic surgery for stones: European Association of Urology endourology up-to-date review[J]. Curr Opin Urol, 2026, 36(3):266-271.
[12] 胡清华,许 浩,刘梦威,等.多模态AI融合成像在无积水肾结石经皮肾镜取石中的应用[J]. 临床放射学杂志, 2026, 45(1):117-121.
[13] Radfar M H, Nasiri M, Shemshaki H, et al. A study on comparative outcomes of totally ultrasonography-guided percutaneous nephrolithotomy in prone versus flank position: a randomized clinical trial[J]. World J Urol, 2021, 39(11): 4241-4246.
[14] Checcucci E, Amparore D, Volpi G, et al. Percutaneous puncture during PCNL: new perspective for the future with virtual imaging guidance[J]. World J Urol, 2022, 40(3): 639-650.
[15] Zhang H, Liang W, Liu Y, et al. Clinical application of ultrasound-CT image fusion technology in percutaneous nephrolithotripsy[J]. Asian J Surg, 2024, 47(7): 3077-3078.
[16] 彭家玺,许陈祥,周红庆,等.导航超声联合光纤输尿管肾镜在无明显积水肾结石PCNL术中的应用[J].微创泌尿外科, 2024, 13(5):303-307.
[17] Cui D, Yan F, Yi J, et al. Efficacy and safety of 3D printing-assisted percutaneous nephrolithotomy in complex renal calculi[J]. Scientific Reports, 2022, 12(1): 417.
[18] Li Y, Xie L, Liu C. Prediction of systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy by urine culture, stone culture, and renal pelvis urine culture: systematic review and meta-analysis[J]. Heliyon, 2024, 10(13): e33155.
[19] 甘兆凯,覃 斌,吴清国,等.融合超声导航系统联合3D打印技术定位在经皮肾镜取石术治疗复杂性肾结石中的应用[J].中国当代医学, 2023, 30(13):111-113.
[20] Zhu X S, Yin X Y, Fu D H, et al. Application of image overlapping in percutaneous nephrolithotomy[J]. Int Urol Nephrol, 2023, 55(12): 3057-3063.
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