输尿管软镜监视下经皮肾镜治疗鹿角状结石11例报告

发布时间：2019-07-08 09:33

【摘要】：目的 :探讨输尿管软镜监视下经皮肾镜治疗鹿角状结石的安全性与有效性。方法 :部分性或完全性鹿角状结石患者11例,先在局麻下用膀胱镜置入双J管。2周后患者全麻下取膀胱截石位,用导丝置入输尿管软镜鞘,利用输尿管软镜进入肾盂或肾盏寻找结石。在B超引导下行经皮肾穿刺,然后在输尿管软镜监视下进行常规经皮肾镜操作,并在术后拍摄腹部平片来评价手术效果。结果:所有手术均顺利完成,无明显并发症,10例(90.9%)患者结石一期完全清除(直径2 mm以下结石视为完全清除),1例由于感染,一期手术未能完全碎石取石,二期经皮肾镜取石术(PCNL)联合输尿管软镜完全清除结石。其中5例有肾镜无法到达的肾盏内结石,经输尿管软镜套石篮取出。输尿管软镜监视下的穿刺与扩张过程更加精确,使得出血量减少,感染和其他并发症的发生率降低。结论:输尿管软镜监视下的同步经皮肾镜治疗鹿角状结石是有效与安全的操作,并且能够提高清石率。
[Abstract]:Objective: to investigate the safety and efficacy of percutaneous renoscopy in the treatment of staghorn calculi under the supervision of soft ureter. Methods: eleven patients with partial or complete staghorn stones were treated with double J tube under local anesthesia. 2 weeks later, the cystolithiasis position was taken under general anesthesia, the soft mirror sheath of ureter was inserted with guide wire, and the stones were found by ureter soft microscope. Under the guidance of B-ultrasound, the puncture of the kidney was carried out under the guidance of B-ultrasound, and then the routine percutaneous nephroscopy was performed under the supervision of the soft ureter, and the abdominal plain film was taken after operation to evaluate the effect of the operation. Results: all the operations were successfully completed without obvious complications. 10 patients (90.9%) had stones completely cleared in one stage (stones less than 2 mm in diameter were completely removed), 1 patient could not be completely removed by primary lithotripsy due to infection, and the stones could not be completely removed by (PCNL) combined with ureteroscopy in the second stage. Among them, 5 cases had calyceal stones which could not be reached by endoscopes and were removed by soft lens basket of ureter. The puncture and dilatation process monitored by soft ureter is more accurate, which reduces the amount of bleeding and the incidence of infection and other complications. Conclusion: synchronous percutaneous nephroscopy under the supervision of soft ureter is an effective and safe operation for the treatment of staghorn calculi, and can improve the stone clearance rate.
【作者单位】：南京医科大学第一附属医院泌尿外科;
【基金】：江苏省科教兴卫工程医学重点学科(XR201111)
【分类号】：R699

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