B超引导侧卧位经皮肾镜取石术1200例报告  

Percutaneous Nephrolithotomy in Lateral Position with Ultrasonography-guidance:A Report of 1200 Cases

作　　者：陈修德[1] 尉春晓[1] 张安学[1] 于江[1] 崔子连[1] 金讯波[1] 

机构地区：[1]山东大学附属省立医院泌尿微创中心,山东济南250014

出　　处：《泌尿外科杂志（电子版）》2012年第2期5-8,共4页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的总结B超引导下侧卧位经皮肾镜取石术(PCNL)的经验、手术技巧及其并发症的防治策略。方法回顾性分析2007年12月至2012年6月采用B超引导下侧卧位PCNL治疗1200例肾、输尿管结石患者的临床资料,分析其疗效及并发症。结果 1200例患者完成手术,总结石清除率为96.6%,首次结石清除率为84.2%,15.8%的残余结石需进一步辅助综合治疗。总并发症发生率为19.3%,107例发热超过38.0℃,占8.9%,5例需输血治疗,占0.4%,没有需介入栓塞止血的病例。27例集合系统穿孔导致大量冲洗液外渗占2.3%,5例周围脏器损伤占0.4%,13例尿脓毒血症占1%,其中6例感染性休克占0.5%,这6例感染性休克均抢救成功,恢复良好。结论侧卧位PCNL相对于俯卧位具有较大的优势,其治疗复杂性肾输尿管结石能使患者更好耐受手术,结石一次清除率更高,合并心肺功能不全的患者均能安全耐受侧卧位手术。Objective To summarize experience of percutaneous nephrolithotomy and improve curative level and operation skills and prevention of complications in percutaneous nephrolithotomy.Methods 1 200 patients were treated with percutaneous nephrolithotomy were retrospective analyzed between 2007 and 2012.Results 1 200 cases were followed up,the total stone free rate was 96.6%,and the primarily stone-free rate was 84.2%,the rate of retained calculus patients needed auxiliary measures(a second PCNL,ESWL,ureterorenoscopy) was 15.8%.Overall,the early complication rate was 19.3%,fever rate was 8.9%,5 cases(0.5%) with blood transfusion,3 csaes(0.3%),without intervention embolism,27 cases(2.3%) rinse solution extravasation were clinical significance,5 cases(0.4%) ambient organ were injured including colon and pleura,13 cases(1.0%) were urosepsis,6 cases(0.5%) were severe urosepsis and septic shock,6 cases of septic shock were rescued successfully.Conclusions PCNL in the lateral position have great advantages than in the prone position,lateral position PCNL for complex renal and ureteral calculi patients was better tolerated operation than the prone.The stone free rate is higher in the lateral position,and the patients can tolerate operation in the lateral position with cardiopulmonary insufficiency.

关 键 词：良性前列腺增生 经尿道前列腺电切术 尿道狭窄 

分 类 号：R699[医药卫生—泌尿科学]