超声引导下经腹腔途径经皮肾镜取石术治疗盆腔异位肾肾结石的疗效分析  

Effect of the ultrasound-guided transperitoneal percutaneous nephrolithotomy in treatment of renal calculi in pelvic ectopic kidney

作　　者：潘生玉 饶婷[1] 程帆[1] 阮远[1] 余伟民[1] Pan Shengyu;Rao Ting;Cheng Fan;Ruan Yuan;Ya Weimin(Department of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院泌尿外科,430060

出　　处：《中华泌尿外科杂志》2018年第9期656-660,共5页Chinese Journal of Urology

摘　　要：目的探讨超声引导下经腹腔途径经皮肾镜取石术治疗盆腔异位’肾肾结石的安全性和临床疗效。方法回顾性分析2016年6月至2017年8月收治的4例盆腔异位肾患者的临床资料，男、女患者各2例。年龄30-67岁，平均47．3岁。左侧盆腔异位肾结石2例（1例有肾盂切开取石术史11年），脊柱畸形左侧盆腔异位肾结石1例，右侧盆腔马蹄异位。肾结石1例。单发。肾盂结石2例；多发结石2例，其中1例主体结石位于肾盂，1例为多发下盏结石。结石大小分别为3．4omx2．1cm、3．0cm×2．1cm、2．8cm×2．4cm、2．1cm×1．9cm。4例均全麻下行超声引导下经腹腔途径经皮肾镜取石术。术中采用超声探头施加一定压力作用于腹壁，使肠管尽可能偏离盆腔异位肾表面。结合术前CTU检查结果，在超声引导下寻找目标肾脏穿刺点。在超声实时监测下穿刺目标肾盏或肾盂，寻找并击碎结石，然后留置F6双J管、F18肾造瘘管。记录结石清除情况、术中术后出血、术后腹腔感染情况等。结果本组4例均通过一次手术碎石并清除结石。4例的手术时间分别为62、59、55、51min，术后住院时间分别为6、6、5、5d。4例均无大出血、肠管及肠系膜血管损伤、腹腔感染、腹腔积液等并发症发生。术后1、3个月复查均未见结石复发。结论超声引导下经腹腔途径经皮肾镜取石术治疗盆腔异位肾结石是安全、有效的。Objective To evaluate the safety and efficacy of ultrasound-guided transperitoneal PCNL for treatment of renal calculi in pelvic ectopie kidney. Methods The clinical data of 4 cases of pelvic ectopic kidney treated in our hospital from June 2016 to August 2017 were retrospectively analyzed. The patientg age ranged from 30 to 67 years with an average of 47.25 years. There were two male and two female patients. 2 cases suffered with left pelvic ectopic kidney stones. One case had right pelvic horseshoe eetopie kidney stones and one case had spinal deformity left pelvic ectopie kidney stones. Multiple stones were found in 2 cases. The mainly stones located in the renal pelvis in one case. Multiple stones in the lower calyx was found in another case. The remaining 2 cases had single stones in the renal pelvis. Stone size was 3.4 cm × 2.1 cm,3.0 cm×2.1 cm,2.8 cm×2.4 cm and 2.1 cm×l.9 cm respectively. And 1 case with renal calculi in left pelvic ectopic kidney had a history of open surgery 11 years ago because of the same situation with pelvic ectopic kidney calculi. In this study, all operation was performed under general anesthesia. The ultrasound-guided percutaueous nephrolithotomy combined with preoperative CTU and intraoperative color Doppler ultrasound was used to find the target renal calyx or renal pelvis. And a certain pressure was applied to the abdominal wall to make the intestinal canal deviate from the surface of the pelvic ectopic kidney as much as possible. Under ultrasound real - time detection,it was punctured into the target renal calyx or renal pelvis to find and break stones. And F6 double J tube and F18 nephrostomy tube were left. Operative and post-operative related details （stone free,bleeding, abdominal infection） were reviewed. Results Stone free rate were 100% （4/4）. The time of operation and hospital stay were 62,59,55,51 rain and 6,6,5,5 days, respectively. None had significant intraoperative and postoperative complications, including haemorrhage, injury of mesenteric vessels, ab

关 键 词：经皮肾镜取石术 经腹腔途径 超声引导 盆腔异位肾结石 

分 类 号：R699.2[医药卫生—泌尿科学]