经皮肾镜取石术式中输尿管逆行插管失败原因分析  

Causes and management of retrograde ureteral catheterization failure in PCNL surgery

作　　者：肖谦[1] 郑鸣[1] 曾铭强[1] 苏继峰[1] 汪家兴[1] 李树人[1] 孙炜[1] 周朝阳[1] 李辉[1] 

机构地区：[1]湘潭市第一人民医院泌尿外科,湖南湘潭411101

出　　处：《现代泌尿外科杂志》2011年第3期244-246,共3页Journal of Modern Urology

摘　　要：目的分析经皮肾镜取石术式中输尿管逆行插管失败的原因,探讨其处理对策。方法回顾性分析32例经皮肾镜取石术式中输尿管逆行插管失败患者的相关资料,依据肾积水的程度分别采用B超定位、经验性非影像学定位、小切口触诊+X线定位建立经皮肾通道。结果 32例患者均顺利建立经皮肾通道,无肠道损伤、胸腹膜损伤、大出血、尿外漏、肾周积液积脓、动静脉漏等并发症发生。结论经皮肾镜取石术式中输尿管逆行插管失败有主、客原因。对此类患者,中度以上肾积水患者,B超定位可建立经皮肾通道;轻度或无肾积水患者,若B超定位穿刺不成功,小切口触诊+X线定位是一种可行的方法。Objective To analyze the causes of retrograde ureteral catheterization failure in PCNL and discuss its＇ management.Methods Clinical data of 32 failed retrograde ureteral catheterization in PCNL were retrospectively analyzed.Based on the condition of hydronephrosis,the percutaneous renal accesses of these cases were established by means of type-B ultrasonic,empirical non-imaging position and a small incision palpation guide plus X-ray localization.Results The percutaneous renal accesses were successfully established in all cases,with no complications such as intestinal injury,pleura,abdominal membrane damage,massive hemorrhage,urine leakage,perirenal effusion emphysema,or arterial venous leakage occurred during or after the procedure.Conclusions There are subjective and objective reasons for the failure of retrograde intubation in PCNL.For cases with moderate or severe hydronephrosis,B super-positioning can establish the percutaneous access.For patients with mild or no hydronephrosis,if B ultrabiopsy was unsuccessful,small incision palpation guide plus X-ray localization could be applied.

关 键 词：上尿路结石 经皮肾镜取石术 B超 X线 

分 类 号：R737[医药卫生—肿瘤]