Abstract:

        Objective: To explore the clinical value of three-dimensional imaging of complex renal calculi with CT data for the access of percutaneous nephrolithotomy (PCNL). Methods: 41 cases of complex renal calculi and 29 cases of simple renal calculi underwent CT scan before PCNL. Image were collected and dealt with the technique of multiplanar reconstruction (MPR) and three-dimensional reformation. The stone distribution and relation with adjacency were observed and optimal performance channel was planned. The renal stone clearance rate and the residual fragments rate among the different choice of the access channel were statistical analysis by SPSS. Results: (1) The stone distribution of two groups and the effect of PCNL treatment were statistical significance. (2) There were no statistical significance between two positions in simple renal calculi group when PCNL was through the access location of the 11th intercostal or 12th subcostal. But there were statistical significance in complex renal calculi group. (3) There were no statistical significance between two calices in simple renal calculi group when PCNL was through the access location of the posterior group of upper renal calices or middle renal calices. But there were statistical significance in complex renal calculi group. Conclusions: (1) The pre-operation plan of CT scan, MPR and three-dimensional reformation may be needed especially in the management of complex stones which achieved a success clinical value. (2) From the observing of PCNL, we could directly view the relationship of the kidney collecting system and the surrounding organs, and select the ideal access location to the stone and pelvicalyceal collecting system (PCS)，and significantly decreases complication rates.

Key words: renal calculi, tomography, three-dimensional imaging, PCNL, operation planning