结肠在平卧位经皮肾穿刺造瘘中损伤的影像解剖学研究  

The Imaging Anatomical Study of Colon Injury of Percutaneous Nephrostomy in Supine Position

作　　者：唐松林[1] 周祥福[2] 温机灵[2] 

机构地区：[1]广东省佛山市南海区盐步医院泌尿外科,广东佛山528247 [2]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中国现代医生》2007年第09X期3-5,共3页China Modern Doctor

摘　　要：目的探讨平卧位经皮肾穿刺结肠损伤的机制和几率,为临床经皮肾镜手术提供理论指导。方法对412例平卧位腹部CT进行回顾性分析,模拟一条自腰椎前切缘分别经过肾上极、肾门、肾下极的穿刺线,将升、降结肠位置分为穿刺线前、线后或线上,前者定义为无潜在损伤风险,后两者定义为有潜在损伤风险,从影像学、解剖学上分析平卧位经皮肾穿刺结肠损伤的机制和概率。结果经左侧肾上极、肾门、肾下极的穿刺中结肠有潜在损伤风险的分别为0例、0例、3例(0.73%);右侧肾上极、肾门、肾下极的穿刺中无1例有潜在损伤风险。结论平卧位行经皮肾穿刺结肠损伤发生机率低,但经皮肾镜术前最好常规行CT检查了解解剖变异,以避免结肠损伤严重并发症的发生。Objective To discuss the risk and mechanism of colon injury of percutaneous nephrostomy in supine position, and provide the theoretical guide for percutaneous nephrostomy clinically. Methods To analyze a series of 412 supine abdominal computed tomography （CT） scans. First, simulate a line of the percutaneous nephrostomy tube from the incisal margin of the lumbar to the upper pole or renal hilum or the lower pole. From an anatomic view point ,if the colon is located anterior to the line or on the line of the pereutaneous nephrostomy tube,it means there is a potential risk of colon injury because of its posterior position to the line. If the colon is located posterior the line, it means there isn＇ t a potential risk of colon injury.And analyze the risk and mechanism of colon injury of percutaneous nephrostomy in supine position. Results In this study, when puncturing the upper pole or renal hilum or the lower pole of the left kidney, the potential risks of injuring the ascending colon were 0,0,0.73% respectively, while the potential risks of injuring descending colon were all 0 when puncturing the right kidney. Conclusion The potential risk of injuring colon for the patient to perform PCNL in supine position is extremely limited. It is better to perform CT scan to identify the unusual anatomy before pereutaneous nephrolithotomy.

关 键 词：经皮肾穿刺造瘘术 平卧位 

分 类 号：R656[医药卫生—外科学]