经肾前组盏入路经皮肾镜取石术29例  

Anterior Calyces Access Percutaneous Nephrolithotomy in 29 Cases

作　　者：李东辉[1] 黄义[1] 程庆[1] 王国任 刘振湘[1] 白志明[1] Li Donghui;Huang Yi;Cheng Qing(Department of Urology,Affiliated Haikou Hospital,Xiangya School of Medicine,Central South University,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院泌尿外科,海口570208

出　　处：《中国微创外科杂志》2020年第7期612-615,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：海南省自然科学基金面上项目(818MS134)。

摘　　要：目的探讨经肾前组盏入路经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)的安全性。方法我院2016年1月~2019年11月采用经肾前组盏入路PCNL治疗占据肾前组肾盏结石29例。气管插管全麻,先取截石位,经膀胱逆行插入F5输尿管导管建立人工肾积水,改俯卧位,超声引导下建立F24经皮肾通道,置入F20.8肾镜寻及结石,采用EMS超声气压弹道碎石清石系统碎石。术后常规留置F6双J管、肾造瘘管和尿管。术后7~10 d复查KUB或CT,评估结石清除率。结果共建立32个前组盏经皮肾通道,其中左侧18个,右侧14个;一期建立23个,二期建立9个。肾结石手术清除率93.1%(27/29),其中目标肾前组肾盏结石清石率为100%。并发症2例(6.9%),包括输血1例,胸膜损伤1例,无因出血严重需行肾动脉超选择性栓塞治疗,无尿源性脓毒血症,无肝脏、脾脏及结肠等损伤,无肾切除及死亡病例。29例术后随访3~6个月,1例合并慢性肾功能不全者,术前血肌酐275μmol/L,术后3个月血肌酐141μmol/L;2例残留结石未见增大:1例残留结石堆积于右肾下盏,长径约16 mm,1例残留结石散在分布于右肾上盏及中盏,最大结石长径约6 mm。结论经肾前组盏入路PCNL是治疗占据肾前组肾盏结石的一种安全有效方法,但需注意手术的操作技巧。Objective To discuss the safety of anterior calyces access percutaneous nephrolithotomy(PCNL).Methods A total of 29 cases with calculi located in the anterior calyces had undergone anterior calyces access PCNL from January 2016 to November 2019.Under general anesthesia by intubation,the patient was placed in lithotomy position,and a F5 ureteral catheter was inserted retrogradely to create artificial hydronephrosis.Then the patients were changed into prone position to establish the F24 percutaneous renal tract under the guidance of ultrasound.The calculi were explored by nephroscope at F20.8 and treated through ultrasonic pneumatic ballistic lithotripsy in EMS.After operation,the F6 double J tube,renal fistula and urinary tube were indwelled routinely.The KUB or CT was performed at 7-10 days after operation to assess stone clearance rate.Results Totally,32 anterior calyces accesses were set up with 18 at left and 14 at right.Among the 32 tracts,23 were at first-stage,and 9 were at second-stage.The stone clearance rate was 93.1%(27/29)and the stone clearance rate of the targeted anterior calyces was 100%.Operation-related complications happened in 2 cases(6.9%),including 1 case of blood transfusion and 1 case of pleura injury.No need to perform the hyper-selective renal arterial embolization for severe bleeding,and no urosepsis happened.Meanwhile,there was no case with injury of spleen,liver,or colon.No nephrectomy or death was encountered.The postoperative follow-ups in 29 cases lasted for 3-6 months.In one case of chronic renal insufficiency,the serum creatinine was 275μmol/L before operation and 141μmol/L at 3 months after operation.There were 2 cases of residual stones which did not increase in size:the stones were accumulated in the lower calyx of the right kidney in 1 case,with a length of about 16 mm,and the residual stones were scattered in the upper and middle calyces of the right kidney in 1 case,with the maximum stone length of about 6 mm.Conclusions Anterior calyces access PCNL is safe and effective f

关 键 词：经皮肾镜取石术 经肾前组盏入路 超声 肾结石 

分 类 号：R699.2[医药卫生—泌尿科学]