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目的:评价320排肾脏CTA(CT血管造影)“在腰肋悬空”仰卧位经皮肾镜碎石术中的应用价值及腰肋悬空仰卧位的影像解剖学特点。方法:2010年9月～2011年7月对23例肾结石患者术前行320排肾脏CTA及三维重建,明确肾脏分支血管分布情况及肾脏与周围脏器毗邻关系,进而设计最佳穿刺路径建立经皮肾穿刺通道。患者平均年龄(49.5±11.5)岁;最大径2～6cm,平均为(2.97±1.29)cm。均采用椎管麻醉;手术体位采用腰肋悬空仰卧位。在B超引导下穿刺肾盂或目标肾盏成功后,依次扩张通道至F16或F20,用钬激光或三代超声将结石完全击碎。术后复查320CTA验证穿刺路径及了解结石残留情况。结果:肾脏320排CTA可清晰显示肾内分支血管分布情况。本组23例患者全部穿刺成功,建立通道满意,一期清石率82.6%(19/23)。所有患者均未输血,无胸膜及内脏器官损伤。术后320排CTA检查显示肾造瘘管位于肾脏无血管区。结论:320排CTA可以明确结石、肾盂肾盏、肾分支血管分布及三者关系,真实反映肾脏与周围器官毗邻关系,以利于设计最佳通道,从而降低大出血及损伤邻近脏器风险。腰肋悬空仰卧位时经腋后线于水平方向进针,可通过肾脏无血管区建立通道。
Objective: To evaluate the value of 320 rows renal CTA (CT angiography) in the “lumbar floating” supine position percutaneous nephrolithotomy and lumbar dorsal avoneal supine position of the image anatomy. Methods: From September 2010 to July 2011, 320 patients with nephrolithiasis underwent CTA and three-dimensional reconstruction before operation in 23 patients with nephrolithiasis. The distribution of renal branches and the adjacent relationship between the kidney and the surrounding organs were determined, and the optimal puncture path was designed Percutaneous renal access. The average age of patients (49.5 ± 11.5) years; maximum diameter of 2 ~ 6cm, with an average of (2.97 ± 1.29) cm. Are using spinal anesthesia; surgical position using lumbar dang supine position. B-guided puncture of the renal pelvis or renal calluses after the succession, followed by expansion of the channel to F16 or F20, with holmium laser or three generations of ultrasound completely crushed stone. 320CTA after operation to verify the puncture path and understand the residual stone. Results: 320 rows of CTA in kidney can clearly show the distribution of blood vessels in the branch of the kidney. The group of 23 patients with successful puncture, the establishment of satisfactory channels, a clear rate of 82.6% (19/23). All patients had no blood transfusion, no pleural and visceral organ damage. Postoperative 320 CTA examination revealed that the renal fistula was located in the avascular area of the kidney. Conclusion: 320 rows of CTA can clear the stones, pyelonephritis, renal branch vascular distribution and the relationship between the three, the true reflection of the adjacent relationship between the kidney and the surrounding organs, in order to facilitate the design of the best access to reduce bleeding and damage adjacent organs risk. Waist ribs dangling supine position through the axillary line in the horizontal direction into the needle, through the renal vasculature to establish access.