彩超引导穿刺在经皮肾镜取石术治疗孤立肾结石中的临床应用价值  

The clinical value of color Doppler ultrasound-guided puncture in percutaneous nephrolithotomy for treatment of stones in solitary kidney

作　　者：陆敏华[1] 何娅娣[2] 邓玮明[1] 罗云[1] 肖恒军[1] 温星桥[1] 高新[1] 李辽源[1] 

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630 [2]中山大学附属第三医院体检中心,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2013年第4期8-10,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金(81001139)

摘　　要：目的评价彩超引导穿刺在经皮肾镜取石术(PCNL)处理孤立肾结石中避免肾血管损伤的临床应用价值。方法回顾分析2007年1月至2012年12月我院由彩超引导的孤立肾结石行PCNL术共53例手术过程,所有患者均进行黑白超声与彩超探查:即先用黑白超声设计入路,探查入路上有无点状、小等号状血管回声,再在同一切面上使用彩超,了解有无肾血流显示;若入路上有明显肾血管经过则重新调整入路,在彩超实时引导下进针。结果 53例患者均手术成功,无动静脉瘘或出血等严重并发症,穿刺成功率100%。53例手术中有8例通过彩超检出原超声设定入路上的肾血管并重新设定入路,有效避免损伤肾血管(χ2=4.75,P<0.05)。术前术后血肌酐差异均无统计学意义(P>0.05)。结论彩超引导穿刺PCNL术处理孤立肾结石能有效减少肾血管损伤的发生,提高手术安全性和减少并发症。LU Ming-hua＊, HE Ya-di, DENG Wei-ming, LUO Yun, XIAO Heng-jun, WEN Xing-qiao, GAO Xin, LI Liao-yuan. ＊Department of Urology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China Objective To evaluate the clinical value of color Doppler ultrasound-guided puncture in percutaneous nephrolithotomy to avoid the injury of renal vessels in solitary kidneys.Methods Between January 2007 and December 2012,53 patients with renal calculi in solitary kidney were treated by PCNL under color Doppler ultrasound guidance in our hospital.The therapeutic effects and complications were the main points of the analysis.All patients were checked by B mode ultrasound and the primary route of puncture were designed,observing if there were any ＂dot＂ shape or ＂little equal mark＂ shape vessles＇ images on the route.Subsequently,color Doppler were used in the same section to detect whether there were any renal blood vessels passing through the route,if there were,the route was modified until it punctured away from any obvious blood vessels.Results All PCNLs were successfully performed.The successful rate of renal punctures was 100%.All procedures had no serious complication such as arterio-venous fistul or hemorrhage.Vessels passing through puncture routes were demonstrated by color Doppler in 8 cases.In these cases,the puncture routes were modified,which efficiently avoided the injury of renal vessels in solitary kidneys（χ2=4.75,P 0.05）.There were no statistical significance in serum creatinine levels between pre-surgery and post-surgery（P0.05）.Conclusions In PCNL for renal calculi in solitary kidneys,the color Doppler ultrasound-guided puncture can definitely avoid the injury of renal vessels,which improves the safety and decreases the chance of complication.

关 键 词：经皮肾镜取石术 孤立肾结石 临床应用价值 彩超引导 引导穿刺 肾血管损伤 严重并发症 治疗 

分 类 号：R692.4[医药卫生—泌尿科学]