B超引导下经11肋间微创经皮肾镜取石术的临床应用  

Clinical application of minimally invasive percutaneous nephrolithotomy via the eleventh intercostal access under B-ultrasonography guidance

作　　者：张泽[1] 胡奇[1] 蔡善淦 邱光槐 袁坚[1] 

机构地区：[1]广州医科大学附属第一医院微创外科中心泌尿外科,广东省泌尿外科重点实验室,广州510230

出　　处：《临床泌尿外科杂志》2015年第4期331-334,共4页Journal of Clinical Urology

摘　　要：目的：探讨B超引导下经11肋间穿刺入路微创经皮。肾镜取石术（mPCNL）的可行性和安全性。方法：回顾性分析我院于2012年3月-2013年9月收治的肾和输尿管上段结石患者共210例，其中142例（67．6％）行B超引导下经11肋间单通道（F18）mPCNL。对结石情况、手术时间、取石情况、是否需再次手术及术中术后并发症等资料进行临床分析。结果：全部患者均成功建立手术通道，手术时间25-200min，平均100min；术中、术后并发症发生率14．8％，Ⅰ期、Ⅱ期取石率分别为78．9％、60．0％，总取石率91．5％，平均住院时间8d。结论：经11肋间穿刺入路对于大部分肾和输尿管上段结石可首选，取石率理想，并发症在可控范围内，手术方法安全可行；利用B超作为其引导方式具有更直观、准确、方便的优势，可减少并发症的发生。Objective： To evaluate the feasibility and safety of minimally invasive percutaneous nephrolithotomy （mPCNL） via the 11th intercostal access under the guidance of B-ultrasound. Method： From March 2012 to September 2013, 142 of 210 patients （67.6 %） with kidney and upper-ureteral stones by single channel （Fls） mPCNL treatment via the 11th intercostal access under B-uhrasonography guidance were retrospectively analyzed. Clinical analyses of operative time, stone extraction situation, whether required reoperation, intraoperative and postoperative complications etc. were taken. Result： All patients were successfully established operative channels. The clinical data were as follows： operative time was 25-200 （average, 100） min intraoperative and postoperative complication rate was 14.8%, the first phase and the second stone removal rate were 78.9% and 60.0% respectively （total rate, 91.5%）; average hospitalization was 8 days. Conclusion： The 11th intercostal puncture approach can be preferred for most renal and upper-ureteral calculi. Stone clearance rate of mPCNL via the 11th intercostal access was satisfactory. The complications were in the controllable range and the surgical methods were feasible and safe. B-ultrasonography as the guidance has more intuitive, more accurate and more convenient advantages and reduces the incidence of complications.

关 键 词：微创经皮肾镜取石术 11肋间入路 肾结石 输尿管上段结石 B超引导 

分 类 号：R692.4[医药卫生—泌尿科学]