Initial experience with computed tomography-ultrasound image fusion guided percutaneous nephrolithotomy (CT-US PCNL) / 中华泌尿外科杂志

ABSTRACT

Objective To explore the safety and efficacy of fusion imaging technique and traditional ultrasound guidance in percutaneous nephrolithotomy,and to compare the difference of two methods for PCNL.Methods Patients with renal calculus,who underwent percutaneous nephrolithotomy from January 2016 to August 2016,were enrolled in the study.The patients were randomly divided into two groups by SAS software.The control group was treated with traditional ultrasound guided puncture technique (Ultrasound group).Experimental group was treated with fusion imaging method (CT-US group).Preoperative patient CT image data was uploaded to the image fusion ultrasound machine for data synchronization.Both groups used the same way to establish a standard channel (F24).Lithoclast system from EMS was used to remove stones.Intraoperative parameters (time to define the target calyx,access establishment time,operative duration) and postoperative perioperative data (estimated blood loss,stone-free rate,severe complications) were compared between the two groups.Results 65 cases of patients were enrolled into the study.There was no significant difference in age (P =0.72),body mass index (P =0.78),stone size (P =0.53) and so on.Compared with the control group,the time duration to define the target calyx in CT-US group is significantly decreased in experiment group(50.4 ± 18.1) s vs.(82.1 ± 37.7) s,(P =0.02).The time to establish the access and fulfill the procedure shows no significant difference between the two groups,respectvely(P =0.45,0.61).Also,significant differences can be found in the hemoglobin loss during and after the surgery(1.1 ± 0.5) g/L vs.(1.4 ± 0.4) g/L (P =0.04).The difference in severe complications (Clavien Ⅲ and above),stone-free rate (P =0.60) and transfusion rate (P =1.00) was not significant.Conclusions Our primary study shows CT-altrasound image fusion guide PCNL is a safe and reliable technology.The time duration to define the target calyx was decreased compared with traditional US guidance method.The target calyx chosen was more accurate,with lower blood loss during the perioperative period.