自制F4．85可视穿刺针联合输尿管通道鞘在超微经皮肾镜碎石术中的应用  

Effect of microperc for treatment of renal calculi with self-made optical puncture needle combined with ureteral access sheath

作　　者：张际青[1] 张军晖[1] 康宁[1] 危彤 王勇[1] 张小东[1] 邢念增[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,100020 [2]首都医科大学第三临床医学院2013级五年制临床专业

出　　处：《中华泌尿外科杂志》2017年第11期852-856,共5页Chinese Journal of Urology

摘　　要：目的探讨自制F4．8可视穿刺针联合输尿管通道鞘行超微经皮肾镜碎石术（microperc）治疗肾结石的疗效和安全性。方法回顾性分析2016年6月至2017年4月收治的23例肾结石患者的临床资料。男12例，女11例。年龄28～67岁（49±14）岁。结石大小1．0～3．012111[（1．7±0．6）cm]，CT值357～1500HU[（934．5±282．7）HU]。23例患者均全麻下行microperc，取斜仰卧截石位。术中采用自制F4．85可视穿刺针联合输尿管通道鞘。自制可视穿刺针包括F4．85穿刺针、2个Y形三通管和微光学纤维束。2个三通管连接后，一端与穿刺针尾端连接，另一端的三个接头分别与微光学纤维束、激光纤维及冲洗管连接，微光学纤维束连接显示器。超声引导下用可视穿刺针穿刺结石所在肾盏、可单一通道处理多发结石的肾盏或能直接抵达肾盂结石的肾盏。与微光学纤维束连接的显示器可同时观察整个穿刺过程。碎石后取出穿刺针，均不留置肾造瘘管，均留置输尿管支架。结果23例均成功留置输尿管通道鞘和穿刺目标肾盏。1例因出血影响视野改为经皮。肾镜取石术，余22例均直视下碎石。1例结石移位需输尿管软镜辅助治疗。手术时间20～120min[（46．2±19．9）min]。术后发热1例（Clavien II级），经抗生素治疗好转；血尿2例（ClavienI级），保守治疗好转，无输血患者。无严重并发症发生。术后第1天疼痛模拟视觉评分为1—6分[（2．8±1．2）分]。术后血红蛋白（134．5±15．0）g/L，与术前（127．7±13．9）g/L比较差异无统计学意义（P〉0．05）。住院时间为2～5d[（2．9±0．8）d]。术后1个月无石率为90．9％（20／22例），2例残留结石直径分别为2mm和3mm，术后3个月复查结石排出。结论自制可视穿刺针结合输尿管通道鞘治疗。肾结石是可行、有效的．并发症少。Objective To evaluate the effect of micropercutaneous nephrolithotomy（microperc） for treatment of renal calculi with self-made F 4.8 optic puncture needle combined with ureteral access sheath. Methods There were 23 patients undergoing microperc with the self-made device from June 2016 to April 2017, Male, 12 cases, female,ll cases. The mean ＋ SD （range） patient age was （49 ＋ 14） years（ 28-67 years）, stone volume was （ 1.7 ± 0. 6） cm （ 1.0 - 3.0 cm） and stone density was （ 934. 5 ± 282. 7 ） HU （357 - 1 500 HU）. The self-made all-seeing system consists of a puncture needle （F4. 85） and two 3-way connector allowing the insertion of a flexible microoptic system, laser fiber and attaching to irrigation system. Single tract with one puncture with ultrasound guide was fit to treat the calices containing calculi or calices at one stage operation. The course of puncture could be ＂ all-see＂ on the display which was connected with flexible microoptic system. After stone fragmentation, the procedure was terminated in tubeless fashion. Ureteral double J stent was inserted in order to prevent postoperative complications. The factors analysed were demographic variables including age, sex, stone volume, stone density [ Hounsfield units （HU） ] and stone location, and intra- and peri-operative variables such as operating time, drop in haemoglobin level,stone clearance and complications. Results Conversion to PCNL was required in one patient because intraoperative bleeding obscured vision. The mean ＋ SD（range） operation duration was （46.2 ：t： 19.9） min （20-120 rain） ,pain score was 2.8 ± 1.2（1-6） , hemoglobin decrease was 6. 6 g/L, and in hospital time was （2. 9 ＋ 0. 8） d（2-5 d） , respectively. No patient required blood transtusinn. Stone-free rate at 1 and 3 months postoperation was 90. 9% （20/22） and 100 % （22/22） , respectively. Two who suffered hematuria （Clavien Ⅰ ）underwent conservative treatment and reeorered well. One suffered u

关 键 词：超微经皮肾镜碎石术 可视穿刺针 输尿管通道鞘 肾结石 经皮 肾镜取石术 

分 类 号：R699[医药卫生—泌尿科学]