标准通道经皮肾镜碎石术前预测方案与术中手术方案差异的分析  

Difference between the preoperative plan and the actual procedure in treatment of staghorn calculi with standard access PCNL under ultrasound guidance

作　　者：胡卫国[1] 李建兴[1] 杨波[1] 黄晓波[1] 王晓峰[1] 

机构地区：[1]北京大学人民医院泌尿外科,100044

出　　处：《中华泌尿外科杂志》2013年第1期17-19,共3页Chinese Journal of Urology

基　　金：北京市科委首都临床特色应用研究课题（Z111107058811007）

摘　　要：目的前瞻性分析超声引导下标准通道PCNL治疗鹿角形结石术中改变手术方案的原因和意义。方法选取2011年2月至2011年5月鹿角形肾结石患者56例，男32例，女24例。年龄18～71岁，平均34岁。均经B超、KUB、IVU、CT等检查确诊。结石位于左侧26例，右侧30例。完全鹿角形结石41例，部分鹿角形结石15例。结石长径13～47mm，平均35mm。硬膜外麻醉下行PCNL，俯卧位，B超引导建立24F标准通道，超声联合气压弹道碎石取石。同一手术医生术前制定手术方案并独立完成手术。比较术中和术前手术方案的差异，分析改变手术方案的原因。结果术中改变穿刺目标肾盏9例（16．1％），改变通道数量15例（26．8％），改变分期10例（17．9％）。导致以上手术方案改变的因素包括：盏颈顺应性、黏膜炎症、结石与黏膜是否粘连、结石质地、碎石效率。结论PCNL术前不能完全预期的因素（盏颈顺应性、黏膜炎症、结石与黏膜是否粘连、结石质地和碎石效率）会影响和改变术中手术方案，改变穿刺目标肾盏、通道数量和分期，相应改变手术难度、手术时间和手术风险，应该提高对这些因素的认知和预见性。Objective To discuss the clinical features and significance of the difference between the preoperative plan and the actual procedure of the treatment of staghorn calculi with standard access PCNL under ultrasound guidance. Methods From Feb 2011 to May 2011, 56 patients withsimple staghorn calculi after standard PCNL under ultrasound guidance were enrolled. The same urologist made the operation plan preoperatively and performed the procedure. The difference between the preoperative plan and the actual pro- cedure were analyzed. The factors leading to the difference were evaluated. Results First puncture calyx, the number of access and stage were changed in 9 （ 16.1% ）, 15 （26.8%）, and 10 （ 17.9% ） patients, respectively. The factors leading to the changes include： flexible, compliance, local inflammation of calyx and texture of stone, efficiency of fragmentation. Conclusions The factors which cannot be clearly known preoperatively may change the procedure of PCNL, which is important to know the clinical features and significance of these factors.

关 键 词：经皮肾镜碎石术 肾结石 外科治疗 

分 类 号：R699.2[医药卫生—泌尿科学]