摘要
目的总结平卧位微穿刺造瘘经皮肾镜碎石取石术的临床经验。方法56例结石患者,结石位于左肾23例、右肾26例、输尿管上段7例。结石大小平均为2．6 cm×1．7 cm,单发结石17例,多发复杂性肾结石26例,肾铸形或鹿角形结石13例,最大铸形结石为5．7 cm×7．2 cm×4．3 cm。伴重度肾积水者9例,轻中度肾积水者29例。患者取平卧位,患侧腰胁部垫高,B超引导下进行穿刺、扩张建立经皮肾微穿刺通道,采用输尿管镜行经皮肾镜碎石取石术。结果56例碎石取石术均成功。1例术中输血200 ml,余55例均未输血。无一例出现严重并发症。一期结石取净40例(71．4％),残留结石16例,其中9例二期手术取净,3例行体外冲击波碎石术治愈,4例未进一步处理。结论平卧位行经皮肾镜碎石取石术患者体位舒适,击碎的结石更易冲出,而且利于麻醉师观察患者,方便气管插管等抢救措施的实施。
Objective To evaluate the technique of performing mini-percutaneous nephrolithotomy （mini-PCNL） in supine position. Methods A total number of 56 patients who underwent PCNL for renal or upper ureteral calculi were carried out by ureteroscope in supine position. The calculi were located in the left kidney of 23 cases, in the right kidney of 26 cases and in the upper ureter of 7 cases, respectively. Seventeen patients had single calculus while 26 others had muhiple calculi. The mean calculus diameter was 2.6 cm × 1.7 cm. Thirteen patients had staghorn calculi with the maximal dimension of 5.7 cm×7.2 cm×4.3 cm. Severe hydronephrosis was found in 9 kidneys and mild to moderate hydronephrosis was found in 29 kidneys. The ipsilateral flank was raised with a 1000 ml saline bag as pad during the procedure. The skin was punctured and the tract was dilated under the guidance of ultrasound to set up the tract for mini-PCNL. Results The successful operation rate was 100% ,while the primary stone clearance rate was 71.4% （40/56）. Residual calculi were found in 16 cases. The additional PCNLs were performed on 9 cases,and the residual calculi were completely removed. Three cases were treated by ESWL in patients who were not willing to accept additional PCNL. The total stone clearance rate was 87.5% （49/56）. Only one case required blood transfusion during the procedure. There was no severe complication during and post-operation. Conclusions The supine position is the most comfortable position for patients accepting PCNL. The stone fragments are much easier to wash out than other positions as well. This position is convenient for anesthetist to observe the patient and to converse to general anesthesia if needed.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2006年第11期728-730,共3页
Chinese Journal of Urology
关键词
经皮肾镜取石术
平卧
Percutaneous nephrolithotomy
Supine
