经皮肾镜联合纤维胆道镜套石篮治疗复杂肾结石68例

发布时间：2018-09-06 18:06

【摘要】：目的探讨经皮肾镜联合纤维胆道镜碎石取石治疗复杂肾结石的可行性。方法 2012年6月~2016年8月采用经皮肾镜联合纤维胆道镜套石篮治疗复杂肾结石68例,硬膜外麻醉或全麻,先截石位,患侧输尿管置入输尿管导管,改俯卧位,患侧第10~12肋下腋后线、肩胛下角线之间为穿刺点,彩超定位经皮穿刺目标盏,置入斑马导丝,扩张建立F22~F24通道,肾镜观察,超声、气压弹道粉碎结石并取出,对肾镜不能看见而无法取出的结石,更换纤维胆道镜,找到结石后用套石篮取出,或者将结石拖至肾盂,超声或气压弹道粉碎后肾镜取出。结果 68例手术均获成功,一期清石率82.4%(56/68),二期清石率92.6%(63/68)。手术时间40~180 min,平均100 min。出血量10~600 ml,平均80 ml。术中并发症8例,包括工作通道丢失(2例)、集合系统损伤(2例)、出血(1例)、穿刺困难(2例)、冲洗液外渗(1例),术后发热6例,均相应处理,恢复好,无严重并发症出现。住院时间7~11 d,平均9 d。66例随访3~6个月,无残余结石和并发症发生。结论经皮肾镜联合纤维胆道镜碎石取石治疗复杂肾结石可行,为无力购买输尿管软镜的基层医院提供一种新方法。
[Abstract]:Objective To explore the feasibility of percutaneous nephrolithotomy combined with choledochofiberscope lithotripsy in the treatment of complex renal calculi.Methods From June 2012 to August 2016,68 cases of complicated renal calculi were treated with percutaneous nephroscopy combined with choledochofiberscope lithotripsy basket. Subcostal axillary posterior line, between the lines of the subscapular angle for the puncture point, color Doppler ultrasound positioning percutaneous puncture target calyx, zebra guide wire, expansion to establish F22-F24 channel, nephroscopy observation, ultrasound, pneumatic ballistic crushing and removal of stones, nephroscope can not see and can not remove stones, replacement of choledochoscope, found stones with a basket to remove, or to remove stones. Results Sixty-eight cases were successfully operated, the first stage stone clearance rate was 82.4% (56/68), the second stage stone clearance rate was 92.6% (63/68). The operation time was 40-180 minutes, the average bleeding volume was 100-600 ml, the average bleeding volume was 80 ml. Eight cases had intraoperative complications, including loss of working passage (2 cases), impairment of collecting system (2 cases), bleeding (1 case). The hospitalization time ranged from 7 to 11 days, with an average of 9 days. 66 cases were followed up for 3 to 6 months without residual stones and complications. Conclusion Percutaneous nephrolithotomy combined with choledochofiberscope lithotripsy for complicated renal calculi is feasible and can not afford to buy ureter. Flexible bronchoscopy provides a new method for primary hospitals.
【作者单位】：平凉市第二人民医院泌尿外科;
【分类号】：R699.2

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