沿肾盏长轴方向经乳头穿刺在微创经皮肾镜取石术中的应用(附视频)  

Application of centesis along the calyces renales long axis through papilla in minimally invasive percutaneous nephrolithotomy

作　　者：刘兆琼[1] 钟林坚 陈丽[1] 李兵才 刘小伟[1] 谢爱荣[1] 李建华[1] 

机构地区：[1]江西省吉安市第一人民医院泌尿外科,343000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2011年第6期11-13,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的总结沿肾盏长轴方向经乳头穿刺在微创经皮肾镜取石术（MPCNL）中应用的临床经验。方法 2009年10月至2011年2月对125例患者行MPCNL,其中无积水肾脏32例,轻中度积水肾脏78例,重度以上积水肾脏15例,穿刺均采用超声引导沿肾盏长轴方向经乳头穿刺的方法,超声下选定目标穿刺盏,然后使穿刺针沿着肾盏长轴方向经过肾乳头达目标肾盏内,然后置入斑马导丝,沿导丝用筋膜扩张器逐级扩张通道直至成功建立工作通道进行气压弹道碎石术。结果 125例均穿刺成功,88例证实成功沿肾盏长轴方向经乳头穿刺,37例未证实经该径路穿刺。88例证实成功沿该径路穿刺者无一例出现大出血以及因出血而中止手术的情况;37例未证实经该径路者有2例因出血影响视野而中止手术,二期手术完成碎石,2例术后6-7d继发性出血经保守治疗（均输血400-600ml）成功止血。无一例因出血而行栓塞治疗或手术切肾者。结论沿肾盏长轴方向经乳头穿刺应用于MPCNL术是一种能有效减少损伤肾脏大血管的安全可行的方法,能降低MPCNL术的大出血的风险。Objective To review the clinical experience of application of centesis along the calyces renales long axis through papilla in minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods One hundred and twenty-five patients underwent MPCNL from October 2009 to February 2011. Among them, 32 patients were without hydronephrosis, 78 patients with mild hydronephrosis and 15 patients with severe hydronephrosis; all centesises were carried along the calyces renales long axis with guidance of ultrasound. First, the aim calyces renales were ascertained, then, the trocar-needle was put in the aim calyces renales through renal papilla and the guide wire was put in through the trocar-needle, at last, channels were built gradually along the guide wire by fascia ditator and lithotrity （URSL） were carried. Results All centesises of 125 patients were successful, 88 patients were proved by the demanded method and 37 patients were not. There was no haemorrhage or operation interruption for haemorrhage among the 88 patients. Two patients had the haemorrhage after six to seven days, but all were cured successfully by expectant treatment and no artery embolism or nephrectomy was needed. Conclusions Application of centesis along the calyces renales long axis in minimally invasive pertaneous nephrolithotomy is an effective and safe method to reduce the injury of renal vessel, and it can reduce the haem-orrhage risk of MPCNL.

关 键 词：肾盏 乳头 穿刺术 出血 

分 类 号：R699[医药卫生—泌尿科学]