微造瘘经皮肾镜吸引清石系统结合超声在治疗鹿角形肾结石中的价值  

Application of a stone-breaking and suction system combined with uitrasonography in the mPCNL of staghorn renal calculi

作　　者：宋乐明[1] 范地福[1] 杜传策[1] 刘泰荣[1] 杨忠圣[1] 钟久庆[1] 彭光华[1] 胡敏[1] 姚磊[1] 彭作锋[1] 朱伦锋[1] 

机构地区：[1]江西省赣州市人民医院南昌大学附属赣州医院泌尿外科,341000

出　　处：《中华泌尿外科杂志》2013年第4期254-258,共5页Chinese Journal of Urology

基　　金：江西省卫生厅普通及重大课题（20092092,20094015）;江西省科技厅科技计划项目课题（20122BBG70128）

摘　　要：目的探讨微造瘘经皮肾镜吸引清石系统结合超声在治疗鹿角形肾结石中的价值。方法回顾性分析2008年8月至2011年4月302例鹿角形肾结石患者的临床资料，男158例，女144例。年龄3．5～65．0岁，平均41．0岁。合并集合系统积水216例，合并集合系统积脓37例；34例有开放取石手术史。患者均应用微造瘘经皮肾镜吸引清石系统结合超声治疗。硬膜外或全麻下，俯卧位，肾脏不固定，术中应用B超引导穿刺建立14—16F通道，利用硬质工作鞘活动灵活的特点，在连续大流量灌注持续低负压吸引下，采用100w钬激光碎石，术中结合B超引导同步吸引取石。结果302例均成功建立通道，共建立通道329个。291例一期手术，11例合并集合系统积脓行造瘘后二期取石。手术采用单通道280例（92．7％）、双通道17例（5．6％）、三通道5例（1．7％）；低位人路通道322个（97．9％），高位入路通道7个（2．1％）。平均每个通道建立时间3．2rain，平均取石时间55．4min。一期结石清除率为89．7％（271／302），单通道一期结石清除率为90．0％（252／280），ESWL或二期经皮肾镜手术后结石清除率为98．0％（296／302）。输血11例（3，6％），术后介入治疗4例（1．3％），术后发热25例（8．3％），无周围脏器损伤，无死亡病例。结论微造瘘经皮肾镜吸引清石系统结合超声治疗鹿角形肾结石，工作鞘活动度大，取石方便灵活。术中应用超声引导快速、安全、准确，通道设计更合理，能够提高单通道一期清石率，手术更安全。Objective To determine the efficacy and practicability of a stone-breaking and suction system combined with ultrasonography in treating staghorn renal calculi by using minimally invasive percuta- neous nephrolithotomy （mPCNL）. Methods From August 2008 to April 2011, we retrospectively review our outcome when using mPCNL to treat staghorn renal calculi in 302 patients with the aid of a stone-break- ing and suction system combined with ultrasonography. There were 158 males and 144 females. Their age ranged from 3.5 to 65.0 years with a mean age of 41.0. There were 216 cases complicated by hydronephro- sis, 37 cases complicated by pyonephrosis and 34 cases having a history of open surgery to remove the stones. During the surgery,the patient was placed in a flat prone position without boosting the abdomen to prevent the fixation of the kidneys. The mPCNL was performed after establishing a percutaneous tract under the guidance of uhrasonography. With the aid of the stone-breaking and suction system including a rigidsheath with high flexibility in movement, the lithotripsy was performed using a 100 Watt holmium laser under continuous large volume saline irrigation. Uhrasonography was also used intraoperatively to guide lithotripsy and stone clearance. Results Percutaneous tracts were established successfully in all 302 cases. There were 291 cases that had lithotripsy on the first surgery and 11 cases that underwent a second-stage lithotripsy due to complicated pyonephrosis. There were 280 cases in which a single percutaneous tract was used, 17 cases in which double percutaneous tracts were used, and 5 cases in which 3 percutaneous tracts were used. Three hundred and twenty two of 329 percutaneous tracts were established using a 12th rib infracostal ap- proach, the remaining 7 percutaneous tracts were established using a 1 lth or 12th rib supracostal approach. The average time in establishing a percutaneous tract was 3.2 min. The average stone clearance time was 55.4 min. Stone clearance rate by one surgery using on

关 键 词：经皮肾镜取石术 微造瘘 吸引 超声 鹿角形肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]