2020年 · 第100卷第46期

Lung cancer is currently the most common and fatal malignant tumor in the world. In 2018, there were more than 2.09 million new cases of lung cancer worldwide, and the number of deaths caused by lung cancer was as high as 1.76 million^[1]。 Lung cancer is the most common cancer in men in China^[2]In 2018, there were about 774,000 new lung cancer cases in China, and about 690,000 people died of lung cancer.

In percutaneous nephrolithotomy (PCNL), it is essential to establish safe access to stone removal with the help of imaging equipment. Literature reports show that the success rate of ultrasound-guided percutaneous lithotomy for non-hydronephrotic kidney stones is significantly lower than that of patients with hydronephrosis (82% vs. 98.2%). In addition, puncture is more challenging for patients with renal dysplasia and scoliosis. The syngo iGuide navigation system is a three-dimensional (3D) virtual needle tracking system that helps predict and observe the trajectory of the needle, enabling real-time monitoring of the target. In order to study the establishment of percutaneous nephrolithotomy access for non-hydronephrotic kidney stones, the study collected the data of 442 patients with non-hydronephrotic kidney stones admitted from May 2014 to May 2015 who needed to establish percutaneous nephrolithotomy access for PCNL. 33 of them underwent C-arm CT with 3D virtual navigation to establish percutaneous nephrolithotomy access after conventional ultrasound-guided operation failed. The results showed that the technical success rate was 97% (32/33). The puncture sites were in the upper calyx of the kidney in 18 cases, the middle calyx of the kidney in 8 cases and the lower calyx of the kidney in 6 cases. One-needle puncture was successful in 22 cases (66.7%), and adjustment of puncture needle was successful in 10 cases (30.3%). A female patient with severe chronic obstructive pulmonary disease had a calculus of 2.5 cm diameter in the inferior calyx of the left kidney. More than 10 attempts to adjust the puncture needle were unsuccessful due to the poor quality of the C-arm CT image due to her difficulty in holding her breath. The calculus-free rate confirmed by CT scan after surgery was 93.8%. Two patients with staghorn calculi had residual calyces in the inferior calyces due to the difficulty of nephroscopy to access the inferior calyces through a single superior calyces channel. One patient (3.1%) experienced fever (39.1 °C) 1 h after establishment of pelvic lithotomy access, which returned to normal after injection of lysypyrine (0.9 g), and one elderly patient (3.1%) experienced a decrease in hemoglobin (5 g/L), was given volume expansion therapy with infusion, no blood transfusion, and the vital signs were stable.