摘要
目的探讨指探法在微创经皮肾镜取石术中的应用价值。方法术前常规逆行输尿管插管,于12肋下缘近肋脊角处作长约2cm的切口达皮下层,钝性分开肌层和腰背筋膜达肾周,食指探摸肾脏,在食指引导下进行肾穿刺,插入导丝,依序扩张直至F18或F20,建立皮肾通道。结果 37例全部穿刺成功,绝大多数是一针穿刺见尿,术中大出血1例,采用直接压迫肾脏而止住。有2例术中通道丢失而采用该法找到原通道。本组一次手术取净结石34例,其余2次取净。本组病例无肾周脏器损伤,无肾周感染,无术后出血。平均住院12d。结论采用指探法行微创经皮肾镜气压弹道碎石术治疗上尿路结石,较标准术式增加了一个小切口,但损伤不大,而通过切口可将原本复杂困难的定点穿刺变得简单、直观、易行,避免周围脏器的损伤,出血时可行肾脏压迫止血,极大地增加了手术的安全性,因此本术式仍不失为一种安全可靠的微创手术。
Objective To study the method in the exploration to minimally invasive percutaneous nephrolithotomy application value.Methods Preoperative conventional retrograde ureteral intubation,at 12 ribs nearly rib inferior ridge angle about 2 cm long where the incision of subcutaneous layers,blunt separate muscularis and lumbar back fascia of renal weeks,the finger felt kidney,in the index finger guided a kidney biopsy,insert lead wire,in order to F18 or F20 expansion,established the skin kidney channels.Results All 37 cases puncture success,most was a needle biopsy see urine,intraoperative hemorrhage due to 2 cases,the direct pressure to kidney and stopped.2 cases in this passage was lost and found the original channels of this method.This group of an operation take net stone 34 cases,the rest take 2 times net.All cases without renal weeks visceral injury,without renal weeks infection,no postoperative bleeding.Average hospitalization were 12 days.Conclusion The method to do ground with minimally invasive percutaneous renal mirror pressure ballistic lithotripsy treatment urinary calculus,a standard operation added a small incision,but the damage is not big,but through the approach will originally complex difficult fixed-point puncture become simple,intuitive,and easy to operate,and avoid the damage of adjacent organs,hemorrhage feasible kidney oppression hemostatic,greatly increases the safety of the procedure,so this procedure is still a safe and reliable minimally invasive surgery.
出处
《中国当代医药》
2012年第3期190-190,192,共2页
China Modern Medicine
关键词
指探法
微创
经皮肾镜
肾穿刺
Finger probing method
Minimally invasive
Percutaneous nephrolithotomy
Renal puncture
