经2种不同原通道Ⅱ期经皮肾镜碎石的经验总结(附19例报告)  

Experience of two-stage percutaneous nephrolithotomy by two different original channels(report of 19 cases)

作　　者：潘铁军[1] 唐猛[1] 杨家荣[1] 魏世平[1] 

机构地区：[1]广州军区武汉总医院泌尿外科,湖北武汉430070

出　　处：《现代泌尿外科杂志》2012年第2期180-182,共3页Journal of Modern Urology

摘　　要：目的总结Ⅰ期采用标准或者微通道的患者Ⅱ期行经皮肾镜碎石的经验。方法回顾性分析19例Ⅱ期经皮肾镜碎石的患者相关资料,其中Ⅰ期采用标准通道9例,Ⅱ期经皮肾镜碎石均未使用同型号的扩张外鞘,结合钬激光和或三代超声均成功碎石取石;Ⅰ期采用微通道10例,其中有明显肾积水者7例,无积水者3例,采用重新穿刺另辟通道或经原通道或经原通道扩张保留同型号外鞘等方法碎石取石。结果Ⅰ期采用标准通道9例患者行Ⅱ期经皮肾镜碎石术,Ⅱ期碎石成功率100%;Ⅰ期采用微通道10例患者Ⅱ期经皮肾镜碎石,其中有6例均重新穿刺另辟通道,3例经原通道碎石取石后仍残留结石后辅助体外冲击波碎石(ESWL)治疗,1例经原通道扩张保留外鞘后碎石也残留结石辅助ESWL治疗,Ⅱ期碎石成功率80%。结论Ⅱ期经皮肾镜碎石取石经原标准通道者无需使用扩张外鞘,可以取得较好的碎石取石效果;有明显积水患者Ⅰ期行经皮肾镜碎石取石者建议直接采用标准通道,而不推荐使用微通道。Objective To summarize the two-stage percutaneous nephrolithotomy experience for patients who had standard or microchannel nephrolithotomy in the first stage.Methods Data of 19 patients who underwent 2-stage percutaneous nephrolithotomy were retrospectively analyzed.Of the 19 patients,9 adopted the standard channel in the first stage.In the second stage,the stones were successfully crushed combined with holmium laser and/or third-generation ultrasound.The other 10 patients adopted microchannel in the first stage,of whom 7 had obvious hydronephrosis.In the second stage,another channel was punctured or the original channel was expanded to crush stones.Results For the 9 patients who adopted the standard channel in the first stage and percutaneous nephrolithotomy in the second stage,the stone free rate was 100%.For the 10 patients who adopted microchannel in the first stage and percutaneous nephrolithotomy in the second stage,6 had to re-puncture;3 used the original channel but the residual stones had to be crushed with extracorporeal shock wave lithotripsy（ESWL）;1 expanded the original channel and retained the outer sheath,but the residual stones had to be removed with ESWL,the stone free rate being 80%.Conclusion Two-stage percutaneous nephrolithotomy with original standard channel can obtain good stone crushing effect without expanding the outer sheath.Patients with hydronephrosis should adopt standard channel in the first stage of percutaneous nephrolithotomy.

关 键 词：经皮肾镜碎石 Ⅱ期 标准通道 微通道 

分 类 号：R697.11[医药卫生—泌尿科学]