经11肋上缘径路微创经皮肾镜处理肾上盏结石23例报告  

To evaluate the safety and efficacy of the supracostal approach of the 11th rib for percutaneous nephrolithotomy in treatment of upper calyx calculi (Report of 23 cases)

作　　者：应向荣[1] 骆振刚[1] 周毅[1] 李俊龙[1] 唐爱娟[1] 潘建刚[1] 

机构地区：[1]绍兴市人民医院泌尿外科,浙江绍兴312000

出　　处：《临床泌尿外科杂志》2008年第10期735-737,共3页Journal of Clinical Urology

摘　　要：目的:探讨经11肋上缘径路微创经皮肾镜术(MPCNL)处理肾上盏结石的安全性及临床疗效。方法:肾上盏多发性结石或鹿角型结石患者23例,男16例,女7例。均作全麻,气管插管选择双腔管,男性为F37,女性为F35。行患侧输尿管逆行插管,改体位为俯卧位,在B超定位下,于腋中线与腋后线之间紧贴11肋上缘进针,针尖方向指向上盏结石穿刺,穿刺时将患侧肺处于负压状态。沿导丝扩张形成F16的工作通道。置入输尿管镜或李逊镜,采用气压弹道碎石器在灌注泵配合下边冲洗边碎石。结果:23例均一期完成手术,无穿刺失败或中转开放手术。手术时间(65.6±14.8)min,出血量(150.2±42.2)ml,1例术中输红细胞2U。结石清除率为86.9%(20/23)。无术中大出血,无肠道、肝脾脏损伤等。1例出现液胸,术后并发症为肾周血肿1例,继发性出血1例。结论:经11肋上缘径路经皮肾镜处理肾上盏结石有足够的手术安全性,手术效果良好。Objective： To evaluate the safety and clinical efficacy of the treatment of upper calyx calculi with minimally invasive percutaneous nephrolithotomy （MPCNL） through the upper edge of the 11th rib pathway. Methods：All of 23 cases （16 males and 7 females） with multiple upper calyx calculi or staghorn calculi underwent general anesthesia. Double-lumen endotracheal intubation were selected, F37 for male and Fa5 for female. Retro-grade intubation of the trouble side ureter was done first. Change the posture to prone position. Under B-type ul- trasound guidance, the needle was placed towards to the upper calyx calculi, close to the upper edge of the llth rib, between axillary midline and posterior axillary line. The lung of trouble side was in vacuum state while puncturing. The track down to the kidney was expanded to F16. Through the ureteroscope or nephroscope, pneumatic lithotripsy and infusion pump were used to crush the calculi. Results：All 23 cases of operation were complete in one stage. No defeat in puncturing, no changing to open surgery. Operation time was （65.6±14.8） min. Hemor- rhage quantity was （150.2±42.3） ml. 1case transfused RBC 2 U in the operation. Calculi clearance rate was 86.9% （20/23）. No huge hemorrhage, no intestine, liver or spleen injury in the operation. 1 case suffered from hydrothorax after the operation. 1 case had the complication of peripheral kidney hematoma and 1 case had the complication of secgndary hemorrhage. Conclusions： The treatment of upper calyx calculi with minimally invasive percutaneous nephrolithotomy （MPCNL） through the upper edge of the 11th rib pathway has sufficient safety and good results.

关 键 词：肾上盏结石 微创经皮肾镜术 

分 类 号：R692.4[医药卫生—泌尿科学]