导丝在经皮肾镜碎石术中的引导作用

发布时间：2018-05-16 12:14

本文选题：经皮肾镜 + 导丝　；参考：《中国内镜杂志》2015年04期

【摘要】：目的探讨导丝在经皮肾镜手术中提高一期结石清除率的临床疗效。方法 30例复杂性肾结石患者均经导丝引导下来提高结石清除率。首先建立一穿刺通道,用超声及气压弹道将视野内结石击碎并冲出体外。如超声检查示有肾盏结石残留,应保留原穿刺通道,超声引导下经有残余结石的肾盏进行穿刺,穿刺成功后将导丝置入肾盂,超声证实导丝位于肾盂内,经第1个穿刺通道进镜寻找导丝,沿导丝寻找肾盏内结石。如因角度太小,沿导丝无法探及结石,则利用导丝建立第2穿刺通道进行碎石。结果 2例因角度太小行两通道碎石,余28例均一通道碎石成功,结石一次性完全清除,2例患者术后第6天出现血尿,无胸膜损伤、尿瘘、感染及大出血等并发症出现。结论经皮肾镜碎石术中导丝的引导作用可显著提高一期结石清除率,尤其对复杂性肾结石患者,可减少多通道碎石引起大出血、感染及尿瘘等并发症的发生。
[Abstract]:Objective to investigate the clinical effect of guiding wire in one-stage stone removal during percutaneous nephroscopy. Methods 30 patients with complicated renal calculi were guided by wire guide to improve the stone clearance rate. First, a puncture passage was established, and the stones in the field of vision were smashed and rushed out of the body by ultrasound and pneumatic ballistics. If ultrasonic examination shows residual renal calcaneal stone, the original puncture passage should be retained. Guided by ultrasound, the guide wire should be inserted into the renal pelvis after successful puncture. The guide wire is located in the renal pelvis. Through the first puncture passage into the mirror to find the guide wire, along the guide wire to find the kidney calyceal stone. If the angle is too small to reach the stone along the guide wire, use the guide wire to establish the second puncture channel for lithotripsy. Results two cases were treated with two-channel lithotripsy because the angle was too small, and the remaining 28 cases were successfully treated with uniform channel lithotripsy. Hematuria, pleural injury, urinary fistula, infection and massive hemorrhage were found in 2 cases after 6 days of complete removal of stones. Conclusion during percutaneous nephrolithotripsy, the guiding effect of guided wire can significantly improve the clearance rate of primary calculi, especially for patients with complicated renal calculi, it can reduce the occurrence of complications such as massive bleeding, infection and urinary fistula caused by multichannel lithotripsy.
【作者单位】：山东省临沂市沂水中心医院泌尿外科;
【分类号】：R699.2

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