多点穿刺标准通道经皮肾镜治疗鹿角形结石的体会  

Multi-point puncture standard channels in percutaneous nephrolithotomy treatment of staghorn calculi

作　　者：徐学军[1] 王磊[1] 尹海军[1] 高景宇[1] 魏洪亮[1] 罗子靖[1] 

机构地区：[1]河北医科大学第一医院泌尿外科,河北石家庄050031

出　　处：《河北医科大学学报》2015年第3期280-282,共3页Journal of Hebei Medical University

基　　金：河北省科学技术研究与发展计划项目(12276104D-62)

摘　　要：目的探讨多点穿刺标准通道术在双导管碎石清石系统治疗鹿角形肾结石中的价值。方法分析268例鹿角形肾结石患者的临床资料,男性148例,女性120例,年龄18~68岁。合并集合系统积水（包括某一肾盏的扩张）186例,积脓26例。均使用标准通道多点穿刺技术双导管碎石清石系统治疗。全麻或硬膜外（分2次手术者）麻醉。彩色多普勒超声引导下建立标准通道,手术中B超实时监测下选择和使用肾盂和肾盏穿刺点。结果268例共建立标准通道270个,选择和使用穿刺点486个,使用4个19例,3个27例,2个107例,1个115例。平均取石时间45.4 min。一期清石率96.7%（259/268）,二期清石率98.9%（265/268）。输血9例（3.4%）。介入治疗4例（1.5%）,术后发热26例（9.7%）。无死亡病例,无肾切除病例。结论彩色多普勒超声实时监测下,使用标准通道多点穿刺技术,在双导管碎石清石系统对鹿角形肾结石的治疗中安全、快速,能够提高清石率,降低手术并发症。Objective To evaluate the feasibility and efficacy of the dual ultrasonic lithotriptor system combined with multi-point puncture standard channels technique in patients with renal staghorn calculi.Methods Analysis was made in 268 renal staghorn calculi patients,males 148,females 120,average age 18-68 years old.Coupled with water collection systems（including the expansion of a kidney）accounted for 186 cases,pyometra amounted to 26 cases.All the patients were treated with dual ultrasonic lithotriptor system combined with multi-point puncture standard channels technique.General anesthesia or peridural anesthesia（in the two stage procedure）was applied.The standard channels,the punctures of renal pelvis and calyces were created under the color Doppler ultrasound guide.Results A total of 270 standard channels,486 point punctures of renal pelvis and calyces were made in the 268 patients.Among them,19 patients treated with 4 punctures,27 patients created with 3 punctures,107 patients created with 2punctures,115 patients created with 1 puncture.The mean calculi removal time was 45.4 minutes.One-stage calculi clearance rate was 96.6%（259/268）.Two-stage calculi clearance rate was 98.9%（265/268）.Nine patients needed blood transfusion（3.4%）.Interventional therapy technique was deployed in four patients（1.5%）.Twenty-six patients complained postoperative fever（9.7%）.No deaths occurred.There were no nephrectomy cases.Conclusion Dual ultrasonic lithotriptor system combined with multi-point puncture standard channels technique guided by color Doppler ultrasound in patients with renal staghorn calculi is safe and effective in quickly removal of calculi,also reducing the complications.

关 键 词：肾结石 肾造口术 经皮 碎石术 

分 类 号：R692.4[医药卫生—泌尿科学]