Design and implementation of optimal puncture pathway for percutaneous nephroscopy in 86 cases of complex renal calculi / 中国基层医药

ABSTRACT

Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy (PCNL)with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi.Methods Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation,CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix,the neck of the calyx and the body surface were regarded as the puncture point on the body surface,and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi,two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy.Results Percutaneous puncture pathways were successfully established in 86 cases,65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3 ± 17.2)min,and the hemoglobin decreased in (10.1 ± 4.5)g/L.The hospitalization time of the patients was (7.2 ± 5.2) d.The first stage stone clearance rate was 74.4％ (64/86),and the second stage stone clearance rate was 95.3％ (82/86).Conclusion Combined with the advantages of X-ray and ultrasound,the puncture route shoud be designed by CT/IVP before operation,and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi.