摘要目的 探讨应用腔内造影超声(intra-cavitary contrast enhanced ultrasound,ICCE-US)引导经皮肾镜取石术(PCNL)在治疗轻度积水或无积水肾结石患者中的可行性和实用性.方法 2016年3月至2017年3月收治的肾结石患者35例.男20例,女15例.年龄28 ～ 75岁,平均46.8岁.单纯肾盂结石10例,肾盂合并肾盏结石17例,部分鹿角形结石8例.结石长径2.5 ～5.0 cm,平均(3.6±1.2) cm.无肾积水24例,轻度积水11例.35例均行ICCE-US引导下PCNL.全麻,患者取俯卧位.B超扫描选定穿刺目标盏后,经输尿管导管逆行注入超声造影剂注射用六氟化硫微泡,位于高位的后组肾盏显影.采用18G穿刺针经肾盏穹窿穿刺进入肾集合系统,拔出针芯,无论有无尿液流出,均经穿刺针顺行注入超声造影剂确认穿刺针头端是否位于肾集合系统内.放置导丝,筋膜扩张器扩张建立经皮肾通道,肾镜下行钬激光碎石.结果 所有患者术中均可通过超声造影剂增强显示的微泡效应识别后组肾盏及肾盏穹窿,通道一次性建立成功率100％.通道建立时间5～ 10 rmin(8.0±2.6) min.成功建立通道所需穿刺次数1～3次(1.5±0.3)次.术后24 h血红蛋白较术前下降6～15g/L(11.3±3.7)g/L,无输血病例.无集合系统穿孔和周围脏器损伤.术后住院时间5～7 d(5.6±1.2)d.一期结石清除率91.4％ (32/35).结论 对于轻度积水或无积水肾结石患者,ICCE-US能更加清晰地显示后组肾盏和肾盏穹窿部,以及经皮肾穿刺针的具体位置,提高经皮肾穿刺的精准性和成功率,降低PCNL手术穿刺相关并发症的发生率.

abstractsObjective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.