复杂性肾结石经皮肾镜取石术86例最佳通道设计与实施  

Design and implementation of optimal puncture pathway for percutaneous nephroscopy in 86 cases of complex renal calculi

作　　者：王贻兵[1] 王侠[1] Wang Yibing;Wang Xia(Department of Urology,Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110000,China)

机构地区：[1]中国医科大学附属盛京医院泌尿外科,沈阳110000

出　　处：《中国基层医药》2019年第11期1339-1342,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨结合X线和超声检查对复杂性肾结石进行经皮肾镜取石术(PCNL)最佳经皮穿刺通道设计与实施的安全性和有效性。方法收集中国医科大学附属盛京医院2015年5月至2018年5月治疗的复杂肾结石患者86例,术前通过CT/静脉肾盂造影(IVP),设计最佳经皮穿刺通道,选择拟穿刺肾盏。将该肾盏穹隆中心-肾盏颈中心轴线与体表交点作为体表穿刺点,该点与肾盏穹隆中心连线为穿刺线。将超声探头置于拟定穿刺点稍下方,根据肾积水或驼峰样结石回声定位后组肾盏顺序,采取二步法穿刺,争取沿该肾盏穹隆中心-肾盏颈中心轴线穿刺。留置导丝,逐步进行通道扩张至F24标准通道,进行弹道或超声碎石取石术。结果86例患肾均成功建立经皮穿刺通道,65例为单通道,21例为双通道。手术时间(从开始穿刺到留置肾造瘘)(65.3±17.2)min,术后血红蛋白下降(10.1±4.5)g/L。患者术后住院时间(7.2±5.2)d。术后复查一期清石率为74.4%(64/86),二期清石率为95.3%(82/86)。结论结合X线和超声检查优点,术前通过CT/IVP设计穿刺路线,术中超声引导下实施穿刺,建立最佳经皮穿刺通道,可完成复杂肾结石的治疗。Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy(PCNL)with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi.Methods Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation,CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix,the neck of the calyx and the body surface were regarded as the puncture point on the body surface,and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi,two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy.Results Percutaneous puncture pathways were successfully established in 86 cases,65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy)was(65.3±17.2)min,and the hemoglobin decreased in(10.1±4.5)g/L.The hospitalization time of the patients was(7.2±5.2)d.The first stage stone clearance rate was 74.4%(64/86),and the second stage stone clearance rate was 95.3%(82/86).Conclusion Combined with the advantages of X-ray and ultrasound,the puncture route shoud be designed by CT/IVP before operation,and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi.

关 键 词：肾结石 泌尿外科手术 经皮肾镜取石术 肾造口术 经皮 诊断技术 泌尿科 放射摄影术 超声检查 穿刺术 

分 类 号：R699.2[医药卫生—泌尿科学]