超声造影技术引导下经皮肾穿刺应用于经皮肾镜取石术的单中心初步经验

发布时间：2018-05-18 06:13

本文选题：经皮肾镜取石术 + 经皮肾穿刺　；参考：《北京大学学报(医学版)》2017年06期

【摘要】：目的:评估超声造影引导肾穿刺建立工作通道用于经皮肾镜取石术的有效性。方法:该回顾性研究纳入20例在北京大学第一医院诊断为肾结石的患者,患者的人口学基线数据、临床特点、手术治疗以及术后情况来自于北京大学第一医院综合病例数据库。全身麻醉后在超声造影技术实时监控下由同一泌尿外科医师进行经皮肾穿刺,再利用钬激光或气压弹道进行碎石,记录患者的基线临床资料、结石特征以及手术过程,最后,利用统计学分析方法评价超声造影引导经皮肾穿刺用于经皮肾镜取石术的安全性和有效性。结果:20例患者均在超声造影引导下成功行肾穿刺建立工作通道,并完成经皮肾镜取石手术。所有患者均成功穿刺入肾集合系统并建立良好的工作通道,仅1例患者接受了二次肾穿刺,并且所有患者均为通过肾中盏穿刺。中位穿刺时间3.9 min(四分位数:2.9~4.6 min),而中位手术时间是112 min(四分位数:98.5~134.5 min)。术后48 h的泌尿系平片(kidney ureter bladder,KUB)显示初步结石清除率为95.0%(19/20),而中位血红蛋白下降水平为10 g/L(四分位数:5.5~14.5 g/L)。2位患者术后出现暂时性发热,并且对抗生素反应良好,除此之外,无其他严重并发症出现。结论:对于处在经皮肾镜取石术手术学习曲线中的泌尿外科医师,使用注射用六氟化硫微泡超声造影引导经皮肾穿刺建立工作通道是一种安全且有效的方法。该技术使肾穿刺过程更加可视化且简单化,可获得相比于普通超声更为清晰的高质量图像。经皮肾镜取石术初学者可能从该项技术中获益从而缩短学习曲线,但是这需要进一步的前瞻性对比研究加以明确和证实。
[Abstract]:Objective: to evaluate the effectiveness of percutaneous nephrolithotomy with ultrasound guided renal puncture. Methods: twenty patients with renal calculi diagnosed in the first Hospital of Peking University were included in the retrospective study. The demographic baseline data, clinical characteristics, surgical treatment and postoperative conditions were obtained from the comprehensive case database of the first Hospital of Peking University. After general anesthesia, percutaneous renal puncture was performed by the same urologist under the real-time monitoring of contrast-enhanced ultrasound, and lithotripsy was performed by holmium laser or pneumatic ballistics. The baseline clinical data, characteristics of stones and surgical procedures were recorded. The safety and efficacy of percutaneous nephrolithotomy guided by contrast-enhanced ultrasound were evaluated by statistical analysis. Results all the 20 cases underwent percutaneous nephrolithotomy under the guidance of contrast-enhanced ultrasonography. All the patients were successfully punctured into the renal collecting system and established a good working channel. Only one patient underwent the secondary renal puncture and all the patients were punctured through the midrenal calyceal puncture. The median puncture time was 3.9 mins (quartile: 2.9 min), and the median operative time was 112 min (quartile: 98.5% 134.5 min). 48 h after operation, urological plain film ureter bladdern Kub showed that the initial stone clearance rate was 95.0 / 20, while the median hemoglobin level was 10 g / L (quartile: 5.5% 14.5 g/L).2) with transient fever and good response to antibiotics. No other serious complications occurred. Conclusion: for urologists in the learning curve of percutaneous nephrolithotomy, it is safe and effective to use sulfur hexafluoride microbubble ultrasound to guide percutaneous renal puncture to establish the working passage. This technique makes the renal puncture process more visual and simplified, and can obtain higher quality images than conventional ultrasound. The beginners of percutaneous nephrolithotomy may benefit from this technique to shorten the learning curve, but this requires further prospective comparative studies to clarify and verify.
【作者单位】：北京大学第一医院泌尿外科;北京大学泌尿外科研究所国家泌尿男性生殖系统肿瘤研究中心;
【分类号】：R699

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