B超引导下经皮肾镜取石术目标肾盏的选择原则

发布时间：2018-03-25 16:03

本文选题：肾结石　切入点：经皮肾镜　出处：《中国微创外科杂志》2015年08期

【摘要】：目的探讨B超引导下经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)目标肾盏的选择原则,以减少手术并发症,提高结石清除率。方法 B超引导下以选择最近皮肾距离、穿刺方向指向肾盂、最大可视操作角度等原则行PCNL治疗肾、输尿管结石358例。结果均成功建立皮肾通道,一次穿刺成功331例(92.5%),2次穿刺成功27例(7.5%)。单通道取石324例(90.5%),多通道取石34例(9.5%)。手术时间35~156 min,平均75 min。结石一期取净295例(82.4%),二期取净33例(9.2%),联合ESWL排净30例(8.4%)。出血19例(5.3%),感染14例(3.9%),集合系统损伤10例(2.8%),经积极治疗后痊愈。304例随访3个月~6年(中位时间3.2年),11例结石复发,行ESWL后排出,其余恢复良好。结论选择正确的目标肾盏,可提高手术成功率,减少损伤和出血,提高结石清除率。
[Abstract]:Objective to explore the selection principle of percutaneous nephrolithotripsy with percutaneous nephrolithotripsy guided by B-ultrasound in order to reduce the complications of operation and improve the stone clearance rate. Methods guided by B-ultrasound, the nearest dermatorenal distance was selected and the puncture direction was directed to the renal pelvis. PCNL was used to treat renal and ureteral calculi on the principle of maximum visual operating angle. One puncture was successful in 331 cases (92.5%), 27 cases (7.5%), 324 cases with single channel stone extraction (324cases) and 34 cases with multi-channel stone extraction (34 cases) with 9.5min. The operation time was 35156min (mean 75 mins). The stone was removed at one stage in 295 cases (82.4min), 33 cases (9.2m) were removed in the second stage, and 30 cases were treated with ESWL. There were 14 cases of infection and 3.9% of infection, 10 cases of collecting system injury and 2.8%. After active treatment, the patients were followed up for 3 months to 6 years (median time 3.2 years), 11 cases of stone recurred. Conclusion selecting the right target kidney calyces can improve the success rate of operation, reduce the injury and bleeding, and improve the stone clearance rate.
【作者单位】：福建医科大学附属漳州市医院泌尿外科;
【基金】：福建省漳州市医院2010年科技计划项目(2010026)
【分类号】：R699.2

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