Abstract：Objective:To investigate the feasibility and clinical application of percutaneous nephrolithotomy (PCNL) in precise puncture under color Doppler ultrasound guidance assisted by three-dimensional CT reconstruction combined with kideney angiography (CTA). Methods:From September 2012 to October 2013, the clinical data of 96 patients with renal calculi undergoing PCNL in precise puncture under color Doppler ultrasound guidance assisted by CTA were retrospectively analyzed. CTA was done preoperatively, and the working channel was dilated until an F16-18 access in precise puncture under color Doppler ultrasound Guidance assisted by CTA,and then received percutaneous nephrolithotomy. Results:CTA provided a clear map of renal vessels, which had an advantage in optimizing percutaneous nephrolithotomy. PCNL was successfully made on all 96 patients. The operative time was 50-160 min [mean (96±47) min]. Residual calculi (>5 mm) were found in 11 cases by postoperative kidney-ureter-bladder X-ray (KUB) and a second PCNL was given. The stone-free rate for renal calculi was 88.5% after the pray procedure. One case had to stop operating because of severe intraoperative hemorrhage. Two cases had severe hemorrhage postoperatively and cured with conservative therapy. Conclusions:CTA provides a clear map of the pelvicalyceal system (PCS) and the renal vascular distribution, and can be use to see stones in all patients and accurately locate their relation to the PCS.CTA enables an accurate prediction of the site of stones and optimal site for placing the percutaneous track. PCNL in precise puncture under color Doppler ultrasound guidance assisted by CTA is effective and safe, which is great worthy of clinical application. The precise puncture under color Doppler ultrasound guidance assisted by CTA might be the first choice for the establishment of skin to kidney access in PCNL.
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