B超引导下微创经皮肾镜取石术穿刺失败的原因分析及方法改进  

Cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy

作　　者：许云飞[1] 刘敏[1] 张海民[1] 黄建华[1] 王光春[1] 康黎[1] 郑军华[1] 

机构地区：[1]同济大学附属第十人民医院泌尿外科,上海200072

出　　处：《中华泌尿外科杂志》2012年第7期525-528,共4页Chinese Journal of Urology

基　　金：上海市卫生局课题（2009145）

摘　　要：目的分析B超引导下微创经皮肾镜取石术穿刺失败的原因，探讨改良方法的穿刺效果。方法回顾性分析2005年5月至2010年5月采用B超引导下微创经皮肾镜取石术治疗的612例上尿路结石患者的临床资料，男393例，女219例。年龄27—68岁，平均48岁。根据建立工作通道的方法分为两组：传统G18穿刺针穿刺组（A组）382例，采用改良后的ARROWRaulerson蓝空针穿刺组（B组）230例。两组术前平均肾盂分离情况分别为24mm和21mm，平均结石最大径分别为3．7cln和3．8cm，两组比较差异无统计学意义（P〉0．05）。比较两组的一次性穿刺成功率、穿刺时间及治疗效果。结果A、B组一次性穿刺失败者分别为29／382例和2／230例，成功率分别为92．4％和99．1％，两组比较差异有统计学意义（P〈0．05）。A、B组的平均穿刺时间分别为5．1min和4．8rain，两组比较差异无统计学意义（P〉0．05）。两组均无穿刺相关的大出血、肾血肿、尿瘘、肾周感染、气胸等并发症发生。A组穿刺失败的原因：患者过度肥胖5例，穿刺针滑脱9例，穿刺通道丢失13例，针道丢失2例；B组：体型过度肥胖1例，穿刺成功清石过程中针道丢失1例。结论患者过度肥胖是导致微创经皮肾镜取石术穿刺失败的重要原因之一，其他原因是各种情形引起的穿刺通道滑脱或丢失。采用ARROWRaulerson蓝空针穿刺建立工作通道的方法操作简单，易掌握，穿刺成功率显著提高，并发症少，效果良好。Objective To analyze the cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy （MPCNL）. Methods A retrospective analysis involved total 612 patients with upper urinary tract lithialisis treated with MPCNL from May 2005 to May 2010. 382 eases were acupunctured by traditional G18 puncturing instrument （group A） , and the other 230 cases were performed by the improved ARROW Raulerson blue syringe （group B）. The average renal pelvis range was 24 tam vs. 21 mm before operation, and largest diameter of renal calculi was 3.7 cm vs. 3.8 cm （P 〉 0.05）. Success rate and time cost as well as therapeutic effect were compared between the 2 groups. Results There were 29 cases of puncturing failure in group A （ totally 382 cases） while only 2 in group B （ totally 230 cases）. The successful rate of establishment of working channel was significantly higher in group B （P 〈 0.05 ）. Average time of puncture procedure was 5.1 min and 4.8 rain respectively （P 〉 0.05 ）. There was no puncturing-related severe complication in any group. The unsuccessful cases in the group A and related causes were： 5 cases for obesity, 13 cases for puncture needle slipping, 9 cases for channel dropout, and 2 cases for needle route dropout. However, only 2 cases failed in group B, the accurate position of calculi was at upper and lower calyx. One case was over-weighted, another was because of pathway-loss during the calculi elimination processs. And the one-off puncture successful rate of A and B group was 92. 4% vs. 99.1% , and the one-off puncture successful rate was significantly higher in group B. Conclusions Over- obesity of patients is an important cause of puncturing failure for sonographically MPCNL. The establishment of working-channel with ARROW Raulerson blue syringe could be feasible and the success rate was significantly higher.

关 键 词：微创经皮肾镜碎石术 穿刺 ARROW Raulerson蓝空针 改进 

分 类 号：R472[医药卫生—护理学]