逆行输尿管造影辅助超声引导下经皮肾穿刺技术处理肾结石合并无积水肾的可行性及安全性研究  

Feasibility and safety of retrograde ureterography combined with ultrasound-guided percutaneous nephrolithotomy for renal calculi complicated with hydronephrosis

作　　者：张义[1] 喻华[1] 汪前亮[2] Zhang Yi;Yu Hua;Wang Qianliang(Department of Urology,the People＇s Hospital of Hanchuan City,Hanchuan 431600,China;Department of Urology,the People＇s Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]汉川市人民医院泌尿外科,湖北汉川431600 [2]武汉大学人民医院泌尿外科,湖北武汉430060

出　　处：《国际泌尿系统杂志》2018年第4期557-561,共5页International Journal of Urology and Nephrology

摘　　要：目的 探讨逆行输尿管造影辅助超声引导下经皮肾穿刺技术处理肾结石合并无积水肾的可行性及安全性.方法 选取2016年4月至2016年7月诊断为肾结石合并无积水肾的患者5例.分为单纯B型超声成像与造影剂增强下超声成像模式进行比较.结果 5例肾结石患者有4例男性和1例女性,平均体重指数为（28.3 ±5.6） kg/m2,平均结石直径为（24.5±12.0） mm.在B型超声下,所有患者都显示无肾脏集合系统扩张,难以识别目标肾盏进行穿刺.通过逆行造影剂注射可以显示肾脏集合系统各肾盏的情况.在B超辅助下可进行准确穿刺,平均穿刺时间为（55.4±44.8）s.所有经皮肾穿刺（percutaneous nephrolithotomy,PCNL）顺利完成,无术中并发症,无超声造影剂注射发生不良事件等.结论 逆行超声造影剂作为肾穿刺辅助手术是一种可行的手段.通过改善集合系统的可视化,它有助于将穿刺针放置在无肾积水的目标肾盏.该研究具有一定的实用价值,可进行技术推广.Objective To investigate the feasibility and safety of retrograde ureterography combined with ultrasound-guided percutaneous nephrolithotomy for renal calculi complicated with hydronephrosis.Methods From April 2016 to July 2016,5 patients with renal calculi complicated with hydronephrosis were selected.B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of optison via an ipsilateral ureteral catheter.Results Five patients （four males and one female） with renal stones underwent percutaneous nephrolithotomy （PCNL） with retrograde ultrasound contrast injection during the study period.Mean body mass index was（28.3 ± 5.6）kg/m2 and mean stone size was（24.5 ± 12.0）mm.Under B-mode ultrasound,all patients demonstrated non-dilated renal collecting systems that appeared as hyperechoic areas,where it was difficult to identify a target calix for puncture.Retrograde contrast injection facilitated delineation of all renal calices initially difficult to visualize under B-mode ultrasound.Renal puncture was then performed effectively in all cases with a mean puncture time of（55.4 ± 44.8） seconds.All PCNL procedures were completed without intraoperative complications and no adverse events related to ultrasound contrast injection occurred.Conclusions Retrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique.By improving visualization of the collecting system,it facilitates needle placement in challenging patients without hydronephrosis.Future larger scale stu-dies comparing its use to standard ultrasound-guided technique will be required to validate this concept.

关 键 词：肾结石 肾造口术 经皮 碎石术 尿路造影术 

分 类 号：R699[医药卫生—泌尿科学]