预先留置双J管在经皮肾镜取石术中应用的临床分析  

Clinical analysis for preset double J tube in percutaneous nephrolithotripsy

作　　者：白福鼎[1] 吴慧锋 文甲明[1] 张楠[1] 郑一春[1] 陈继民[1] 杜传军[1] 

机构地区：[1]浙江大学医学院附属第二医院泌尿外科,杭州310009

出　　处：《中华医学杂志》2018年第6期454-456,共3页National Medical Journal of China

摘　　要：目的探讨经皮肾镜取石术中预先留置双J管的临床效果及可行性。方法回顾性分析了2014年6月至2017年2月浙江大学医学院附属第二医院74例接受经皮肾镜碎石取石术（PCNL）手术的肾结石患者的临床资料。74例患者中男54例，女20例，年龄27～78（49．5±12．3）岁。结石直径20～59（29．4±4．3）min。手术方法为先截石位通过经尿道输尿管镜下患侧输尿管预先留置Fr6双J管，随后留置三腔Foley导尿管并夹闭引流腔，袋装3000ml生理盐水（高度60—80cm）连接冲洗腔。改俯卧位后经冲洗腔灌注生理盐水，产生人工肾积水后由B超引导下建立经皮肾穿刺通道Fr20，并行一期钬激光碎石取石术。结果所有患者均成功完成经皮肾穿刺并建立Fr20通道，通道建立时间（8．0±2．0）min，手术时间（79±46）min，血红蛋白下降值（17．0±4．0）g/L，血肌酐上升（3．1±1．1）μmol／L，结石取尽率81．1％，并发症发生率8．1％（1例损伤胸膜并发气胸，1例术后形成动静脉瘘大出血，4例术后高热）。结论经皮。肾镜取石术中预先留置双J管是一种安全、可行的方法，有利于经皮肾通道的穿刺和建立，且可避免顺行留置双J的盲目性。Objective To evaluate the clinical application and effect of preseting Double-J ureteric stent in percutaneous nephrolithotripsy. Method 74 cases of renal calculi treated with PCNL in our hospital during June 2014 to February 2017 were retrospectively analyzed. Of 74 cases,54 was male,20 was female. All cases were aged 27 to 78, the mean age was （49.5 ± 12. 3） years old. The diameter of the stone was 20 to 59 mm, and the mean diameter was of （29.4 ± 4. 3） mm. Our Surgical methods was first putingFr6 double J tube in abnormal ureteral in advance in lithotomy position, then indwellingthree-way Foley catheter and clipping drainage port, perfusingirrigation port with 3 000 ml saline from 60 - 80 cm height. Perfusingsaline through irrigation port in prone position, we produce artificial hydronephrosis, then indwelling channel Fr20 through B ultrasound guided percutaneous nephrostomy, and removing renal calculi using holmium laser lithotripsy. Results All patients were successfully completed percutaneous nephrostomy and indwell Fr20 channel, mean channel set up time （8. 0 ± 2. 0） min, mean operation time （79 ± 46） min, mean decline of hemoglobin （ 17. 0 ±4. 0） g/L, mean serum creatinine increased（3.1 ± 1.1 ）μmol/L, one-stage stone-free rates 81.1%, complication rate 8. 1% （1 case injured pleura and suffered from pneumothorax, 1 case suffered from massive hemorrhage of renal arteriovenous fistula after operation, 4 cases suffered postoperative fever）. Conclusion Advance in percutaneous nephrolithotripsy indwelling double J tube is a safe and feasible method, which is advantageous to the percutaneous renal puncture and the establishment of channels, and can avoid the blindness of alonz the line of indwellin~ double .I.

关 键 词：肾结石 经皮肾镜取石 预先留置双J管 穿刺 

分 类 号：R699.2[医药卫生—泌尿科学]