导丝在经皮肾镜碎石术中的引导作用  

The lead role of guide wire in percutaneous nephrolithotomy

作　　者：熊升远[1] 阮同德[1] 徐英民[1] 张京东[1] 孟凡敏[1] 齐强元[1] 刘源[1] 程培伟 袁令兴[1] 陈西良[1] 

机构地区：[1]山东省临沂市沂水中心医院泌尿外科,山东沂水276400

出　　处：《中国内镜杂志》2015年第4期390-392,共3页China Journal of Endoscopy

摘　　要：目的探讨导丝在经皮肾镜手术中提高一期结石清除率的临床疗效。方法 30例复杂性肾结石患者均经导丝引导下来提高结石清除率。首先建立一穿刺通道,用超声及气压弹道将视野内结石击碎并冲出体外。如超声检查示有肾盏结石残留,应保留原穿刺通道,超声引导下经有残余结石的肾盏进行穿刺,穿刺成功后将导丝置入肾盂,超声证实导丝位于肾盂内,经第1个穿刺通道进镜寻找导丝,沿导丝寻找肾盏内结石。如因角度太小,沿导丝无法探及结石,则利用导丝建立第2穿刺通道进行碎石。结果 2例因角度太小行两通道碎石,余28例均一通道碎石成功,结石一次性完全清除,2例患者术后第6天出现血尿,无胸膜损伤、尿瘘、感染及大出血等并发症出现。结论经皮肾镜碎石术中导丝的引导作用可显著提高一期结石清除率,尤其对复杂性肾结石患者,可减少多通道碎石引起大出血、感染及尿瘘等并发症的发生。[ Objective ] To study the application of guide wire in percutaneous nephrolithotomy for improving the stone free rate. [Methods] 30 patients with complex renal calculi were guided by the guide wire to improve stone free rate. First, a puncture channel was established, the visible stones were crushed by ultrasound and （or） pneumatic and then removed out of the body. If there were residual stones in any calyx inaccessible with the ureteroscope, another puncture was made under the guidance of ultrasound to the calyx with residual stones. The guide wire was inserted through the needle to the pelvic, and the ureteroscope was inserted through the first puncture channel to find the guide wire, along which the calyx calculi were observed. The guide wire was withdrawn if the stones could not be touched by the guide wire because of a bad angle, and the second puncture channel was estab- lished along the guide wire to crush stones. [ Results ] Two-channel fragmentation of stones were performed in 2 pa- tients due to a bad angle, lithotripsy was successful in the other 28 patients with a stone free rate of 100%. Hema- turia occurred in 2 patients on the sixth day after surgery. No pleural injury, urinary fistula, infection, hemorrhage and other complications occurred. [ Conclusion] Guide wire can significantly improve the stone free rate of percuta- neous nephrolithotomy lithotripsy, especially for patients with complex-type kidney stones, decrease the blood loss, infection, urinary fistula and other complications.

关 键 词：经皮肾镜 导丝 复杂性肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]