B超引导下经皮肾镜取石术目标肾盏的选择原则  

Selection Principle of Target Renal Calices in Percutaneous Nephrolithotomy Under Ultrasound Guidance

作　　者：林海利[1] 郑周达[1] 刘宏杰[1] 沈在雄[1] 张朝贤[1] 杨明根[1] 

机构地区：[1]福建医科大学附属漳州市医院泌尿外科,漳州363000

出　　处：《中国微创外科杂志》2015年第8期699-700,704,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省漳州市医院2010年科技计划项目(2010026)

摘　　要：目的探讨B超引导下经皮肾镜碎石取石术（percutaneous nephrolithotomy,PCNL）目标肾盏的选择原则,以减少手术并发症,提高结石清除率。方法 B超引导下以选择最近皮肾距离、穿刺方向指向肾盂、最大可视操作角度等原则行PCNL治疗肾、输尿管结石358例。结果均成功建立皮肾通道,一次穿刺成功331例（92.5%）,2次穿刺成功27例（7.5%）。单通道取石324例（90.5%）,多通道取石34例（9.5%）。手术时间35～156 min,平均75 min。结石一期取净295例（82.4%）,二期取净33例（9.2%）,联合ESWL排净30例（8.4%）。出血19例（5.3%）,感染14例（3.9%）,集合系统损伤10例（2.8%）,经积极治疗后痊愈。304例随访3个月～6年（中位时间3.2年）,11例结石复发,行ESWL后排出,其余恢复良好。结论选择正确的目标肾盏,可提高手术成功率,减少损伤和出血,提高结石清除率。Objective To investigate selection principle of target renal calices in ultrasound guided percutaneous nephrolithotomy （PCNL） , in order to reduce the operation complications and improve the stone clearance rate. Methods Under the guaidance of B-ultrasonography, principles of selecting the shortest distance of skin to renal, puncture direction heading to the renal pelvis, and maintaining the largest performance vision angle were utilized in PCNL operations for treating 358 cases of renal and ureteral calculi. Results Percutaneous renal access was successfully established in all the 358 cases, with one-stage puncture in 331 cases （92.5%） and two-stage puncture in 27 cases （7.5%）. The stones were removed via single channel in 324 cases （90.5%） and via multi-channel in 34 cases （9.5%）. The operation time was 35 -156 min, with an average of 75 min. The calculi were removed in one stage in 295 cases （82.4%） , in two stages in 33 cases （9. 2% ） , and in combination with ESWL in 30 cases （8.4%）. There were 19 cases of hemorrhage （5.3%） , 14 cases of infection （3.9%） , and 10 cases of collection system injury （2.8%） , all of which were cured after active treatment. Follow-up reviews for 3 months -6 years （median, 3.2 years） in 304 cases found 11 cases of recurrence which required a reoperation of ESWL and the smooth recovery in the remaining cases. Conclusion Selecting proper target renal calices can improve the success rate of operation, with less damage and bleeding and an improved stone clearance rate.

关 键 词：肾结石 经皮肾镜 目标肾盏 

分 类 号：R699.2[医药卫生—泌尿科学]