一种新的经皮肾镜通道建立方法:刺激性利尿一步扩张法通道建立技术  

Novel nephrostomy tract creation technique for percutaneous nephrolithotomy:real one-step dilation technique accompanied with stimulated diuresis

作　　者：李文成[1] 梁华庚[1] 石瑛[1] 杨雄[1] 汪良[1] 潘峰[1] 邢毅飞[1] 鞠文[1] 章小平[1] 曾甫清[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《临床泌尿外科杂志》2015年第6期514-517,520,共5页Journal of Clinical Urology

摘　　要：目的：肾造瘘通道的建立是经皮肾镜取石术（PCNL）的关键步骤,近年来我们建立了一种新的刺激性利尿一步扩张法通道建立技术,摈弃了传统的输尿管逆行插管操作和多步扩张操作,极大的简化了操作步骤。本文拟研究该通道建立技术在PCNL手术中的安全性和有效性。方法：选取2014年8月～2015年3月顺序入院的50例复杂性肾脏输尿管结石患者为研究对象。所有患者均采用刺激性利尿一步扩张法通道建立技术行PCNL手术。患者麻醉完善后,先留置导尿管,予以夹闭,同时静脉输注生理盐水500～1 000 ml。改为俯卧位后,静脉输注40mg速尿,6min后开始进行肾脏集合系统穿刺和通道扩张操作。观察和记录通道建立时间、整体手术时间、肾脏出血量、总肾功能变化、结石碎片下移进入输尿管例数、通道建立失败例数、集合系统穿孔、输血例数和输血量等研究指标。结果：所有患者均可诱导出肾盏颈管扩张,均成功一次建立取石通道,无通道建立失败和集合系统穿孔病例,无需要输血治疗病例。通道建立时间为（1.9±0.5）min,整体手术时间为（34.6±23.8）min,一次手术结石取净率为88%。结论：本研究结果表明,在PCNL手术中采取刺激性利尿一步扩张法通道建立技术是可行的、有效的和安全的,值得临床进一步推广应用。Objective：The creation of the nephrostomy access is a critical step for a successful percutaneous nephrolithotomy（PCNL）.In recent years,we established a novel nephrostomy tract creation technique,a real one-step dilation technique accompanied with stimulated diuresis.We focused on the feasibility and safety of our one-step dilation technique based on stimulated diuresis for PCNL in the present clinical study.Method：We included consecutive 50 patients from our department who ultimately underwent the modified PCNL from August,2014 to March,2015.The patients received continuous epidural anesthesia and a single dose of antibiotic intravenously.A urethral catheter was introduced,but closed by a clamp temporarily.Patients were placed in the prone position with a pad below the lower abdomen.Then 500-1 000 ml of normal saline was administered intravenously in 30-60 min followed by a shot of furosemide（40mg）.Six minutes after the diuretic injection,an 18-gauge needle was introduced into the fornix of the targeted calyx under a real-time grayscale ultrasonograhic guidance,followed by guidewire introduction and one-step tract dilation.Clinical data including successful access rate,nephrostomy tract creation time,pre-and postoperative hemoglobin value and serum creatinine concentrations,stone-free rate and complications were recorded and evaluated.Result：The distention of the renal infundibulum was successfully induced by the diuresis treatment in all the patients.The successful access rate was 100%.The average time for creating the access and finishing the operation were（1.9±0.5）min and（34.6±23.8）min,respectively.Thestone-free rate was 88%.No major complications,like pleural,vascular or adjacent organ injuries or collecting system perforation were seen.No blood transfusion was needed.Conclusion：The outcomes of clinical practice demonstrate that a real one-step dilation technique accompanied with stimulated diuresis for PCNL is feasible,safe and effective.It is worthy of further development for clin

关 键 词：经皮肾镜取石术 肾造瘘通道 一步扩张法 刺激性利尿 

分 类 号：R692.4[医药卫生—泌尿科学]