局麻下二期经皮肾镜取石治疗肾输尿管上段结石  

The treatment of upper ureteral calculi with second-stage percutaneous nephrolithotomy under local anesthesia

作　　者：周明[1] 江咏[1] 刘勇[1] 果佳[1] 李宏 宋玲[1] 

机构地区：[1]解放军第五十九医院泌尿外科,云南开远661600

出　　处：《中国病毒病杂志》2009年第6期449-451,共3页Chinese Journal of Viral Diseases

摘　　要：目的探讨局部浸润麻醉下二期经皮肾镜取石治疗肾及输尿管上段结石的疗效及安全性。方法采用局部浸润麻醉加杜冷丁、非那根镇痛下行二期经皮肾镜取石治疗肾输尿管上段结石205例,其中,男性130例,女性75例,年龄18~72岁,平均43岁。其中左肾多发性结石59例,右肾多发性结石74例,双肾多发性结石50例,输尿管上段嵌顿性结石20例,孤立肾多发结石2例。结石直径1.2~7.3 cm,平均4.0 cm。结果1次取石108例,2次取石82例,3次取石15例。结石取净率91.7%,采用单通道取石195例,双通道取石10例。患者平均住院16 d。除15例感染性结石术后次日有短暂发热外,无术中术后大出血而需输血或中转开放手术,无水中毒、胸膜穿孔。发生1例结肠穿孔,拔除造瘘管自行愈合。结论局部麻醉下二期经皮肾镜取石治疗肾输尿管上段结石较安全,对机体内环境侵袭干扰小,治疗期间病人的护理及生活质量也提高,具有高效、经济、安全、并发症少等优点。尤其适合合并慢性肾功能不全尿毒症、贫血、感染性结石、肾盂积脓、孤立肾结石及高危的肾输尿管上段结石患者。Objective To explore the efficacy and the safety of second-stage percutaneous nephrolithotomy(PCNL)in treatment of upper ureteral calculi under local anesthesia.Methods A total of 205 cases with upper ureteral calculi aged 18-72 years(mean age:43 years,130 males,75 females)were subjected to secound-stage percutaneous nephrolithotomy,among which,59 were with multiple stones in left kidney,74 with multiple stones in right kindey,50 with multiple stones in both kidney,20 with impacted upper-ureteral calculi,and 2 with solitary multiple kidney stones.The diameters of stones ranged from 1.2 to 7.3 cm,with the average value of 4.0 cm.Results One hundred and eight cases underwent single-session PCNL procedure;82 cases received second PCNL procedure;and 15 cases received third PCNL procedure.The stone-free rate was 91.7%.One hundred and ninety five patients received unilateral PCNL,and 10 received bilateral PCNL.The average hospitalization time was 16 days.Transient fever occurred in 15 cases at the second day after operation.No transfusion due to intraoperative and postoperative bleeding occurred.Also no water intoxication and pleural perforation occurred in the patients.Only one case complicated with postoperative colonic perforation,and was cured after extraction of the cannula.Conclusion The treatment of upper ureteral calculi with second-stage percutaneous nephrolithotomy under local anesthesia is safe and effective.The operation has the advantages of being efficient,economic,security,and having fewer complications.

关 键 词：肾结石 经皮肾镜取石术 局部麻醉 

分 类 号：R699[医药卫生—泌尿科学]