摘要
目的探讨B超引导下Ⅰ期经皮肾镜超声气压弹道碎石清石系统联合钬激光碎石治疗复杂性肾结石的疗效。方法全身麻醉下截石位经膀胱镜先向患侧逆行插入F5输尿管导管，改变体位为俯卧位，在B超引导下穿刺目标肾盏成功后，筋膜扩张器从F8逐渐扩张至F20建立通道，经皮肾镜下超声气压弹道碎石联合钬激光碎石清石。结果单侧单通道取石92例，单侧双通道取石11例，单侧三通道取石1例；双侧单通道取石13例，一侧双通道一侧单通道取石3例。手术时间（72±24）min。术中出血量50—150mL，平均80mL，无术中输血。2例术后继发出血，1例非手术治疗后缓解，1例在DSA下行超选择性肾动脉栓塞止血。术后住院时间7～14d，平均10d；无感染性休克、水吸收、水中毒、胸腔积液等并发症出现。术后1周复查CT，结石取净率为91．7％（110／120）；10例残余结石直径均〈5mm，无需再次手术取石，予口服排石药、大量饮水及适量运动等处理。所有患者术后随访6～18个月，无泌尿系感染、结石复发、肾周积液等远期并发症。结论只要建立合适的经皮肾通道、术中操作规范、联合使用超声气压弹道碎石清石系统与钬激光，B超引导下Ⅰ期经皮肾镜完成清石是完全可以做到的。且手术时间短、清石效率高、创伤小、远期并发症少、安全有效，值得临床推广应用。
Objective To assess the clinical efficacy of ultrasonography guidance percutaneous nephrolithotomy Ⅰ period combining pneumatic ultrasosonic and holmium laser lithotrips of complex renal calculi. Methods Patients were under the general anesthesia in lithotomy position. By cystoscope first to one side retrograde insertion F5 ureteral catheter, the position to prone position was changed. Under ultrasonography guidance puncture target after the success of the calyx, fascia dilator gradually expanded from F8 to F20 channel was established. Then porcutaneous nephroscope combining pneumatic ultrasosonic and holmium laser lithotripsy were administrated. Results One sided single channel was 92 cases, one sided dual channel was 11 cases, one sided three - channel was 1 case. On both sides single channel was 13 cases ,one side of the dual channel and other side of the single channel was 3 cases. The operation time was （72 Ⅰ 24）min. Intraoperative bleeding was in 50 - 150mL, with an average of 80mL, and there＇s no intraoperative blood transfusion. 2 cases of postoperative had secondary bleeding,in which 1 case remitted after non -operative treatment, the other case was treated in DSA downward super selective renal artery embolization to stop the bleeding. Postoperative hospital stay was 7 - 14d, with an average of 10d. There were no septic shock, water uptake, water intoxicationand complications such as pleural effusion. One week after the CT, stones free rate was 91.7% （ 110/120）, in which 10 cases of residual stone with diameter 〈 5mm, needn＇t surgery removed again. They were treated with oral platoon stone drugs, drinking lots of water and a moderate amount of sports such as processing. All cases were followed up for 6 months to 18 months,with no urinary tract infection, stone recurrence and the longterm complications such as perinephric space effusion. Conclusion As long as establish proper percutaneous renal channel,with intraoperative operating norms, combining pneumatic ultrasosonic and holmium laser, ultrasonography guidance percutaneous nephrolithotomy I period clear renal calculi is completely can be done. And it can shorten operation time, and has clear renal calculi with .high efficiency, small trauma and less long -term complications. It is safe and effective, and worthy of clinical popularization and application.
出处
《中国基层医药》
CAS
2016年第1期66-70,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
超声检查
经皮肾镜碎石术
肾结石
超声气压弹道碎石系统
钬激光
Ultrasonic inspection
Uhrasonography guidance
Renal calculus
Pneumatic and ultrasound lithotrips
holmium laser
