一步扩张法在微创经皮肾镜取石中的应用

发布时间：2018-06-17 08:48

本文选题：一步扩张 + 经皮肾镜取石术　；参考：《中国内镜杂志》2017年10期

【摘要】：目的探讨一步扩张法建立微创通道经皮肾镜取石术(MPCNL)治疗上尿路结石的有效性和安全性。方法回顾性分析2011年2月-2015年3月该院一步扩张法建立微创通道经皮肾通道治疗上尿路结石2 813例的临床资料。结果 2 813例患者一步扩张,所有通道均成功建立。其中单通道取石2 383例(84.71%),多通道取石430例(15.29%)。平均通道建立时间(2.3±0.8)min,平均手术时间(78.6±41.1)min。一期手术清石率78.59%,出院时结石清除率89.29%,术后1个月结石清除率为91.50%。术后输血93例,选择性肾动脉栓塞术21例。毗邻脏器损伤:胸膜损伤9例,结肠损伤1例(经保守治疗好转),尿外渗13例,肾周血肿15例,无肝脾损伤。感染性休克2例,抗感染处理后好转。结论 MPCNL中使用一步扩张法建立通道,迅速、安全有效,能减少X线暴露和节约手术时间,但并不增加通道的出血风险。
[Abstract]:Objective to evaluate the efficacy and safety of one-step dilatation in the treatment of upper urinary calculi by percutaneous nephrolithotomy (MPCNL). Methods the clinical data of 2813 patients with upper urinary calculi established by one-step dilation from February 2011 to March 2015 were retrospectively analyzed. Results in 2 813 patients, all channels were successfully established by one step dilatation. Among them, there were 2 383 cases of single channel stone extraction and 430 cases of multi channel stone extraction. The mean channel setting time was 2.3 卤0.8 min, and the average operative time was 78.6 卤41.1 min. The stone removal rate was 78.59, and the stone clearance rate was 89.29 at the time of discharge. The stone clearance rate was 91.50 at one month after operation. Postoperative blood transfusion was performed in 93 cases and selective renal artery embolization in 21 cases. There were 9 cases of pleural injury and 1 case of colon injury (13 cases of urinary exosmosis, 15 cases of perirenal hematoma, no liver and spleen injury). 2 cases of septic shock improved after anti-infection treatment. Conclusion One-step expansion in MPCNL is rapid, safe and effective. It can reduce X-ray exposure and save operation time, but it does not increase the risk of bleeding.
【作者单位】：广州医科大学附属第五医院泌尿外科;浙江省台州恩泽医疗中心(集团)恩泽医院泌尿外科;
【分类号】：R699.2

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