摘要
目的评价彩超定位引导穿刺在小儿经皮肾镜碎石术中的安全性和优势。方法回顾性分析2006年5月-2011年8月应用彩超定位引导穿刺的微创经皮肾镜取石术治疗5岁以下患者上尿路结石患者165例。全部采用超声引导穿刺的微通道（12-16F）经皮肾镜碎石术，气压弹道和／或超声碎石系统击碎并清除结石。结果本组结石平均直径为（15．82±6．31）mm。所有病例均在彩超定位引导下一期成功建立通道并处理结石，通道建立时间为（11．7±5．3）rain，手术时间为（42．6±20．1）min。净石率为95．2％（157／165）。术后69．7％（115／165）的患者出现血红蛋白和红细胞压积下降，血红蛋白平均下降2．67∥L，红细胞压积平均下降2．21％。术后23．03％（38／165）的患者超过48h的持续性或反复发热（≥38．5℃）。无失肾、死亡病例，无术后输血病例，无感染休克病例，无邻近脏器损伤病例。结论彩超定位引导穿刺在小儿微创经皮肾镜皮肾通道建立中能够充分清晰地显示人路上各层组织，肾周脏器毗邻关系，明确、客观、实时的显示肾血管并实时引导避开血管引导穿刺，有效减少术中出血、损伤等并发症，是安全、可靠的定位引导工具。
Objective To evaluate the advantages of color doppler uhrasonography guidence in mini-invasive percutaneous nephrostolithotripsy（mPCNL） for pediatric patients. Methods From May 2006 to August 2011, a total of 165 pediatric cases with upper urinary stone, who were treated by mPCNL with F12-F16 access route, were respectively reviewed. All procedures were under the guidance of color doppler uhrasonography, and the pneumatic lithotripsy and/or EMS ultrasound lithotripsy were used to disintegrate the stones. Results In one-stage mPCNL, The average length of the stones was （15.82 ± 6.31 ） mm, all 165 cases were treated, during which percutaneous renal access was successfully established under color doppler ultrasound guidance and stones were fragmentated. The mean duration of renal access establishment was （11.7 ±5.3） rain. The one-stage stone free rate was 95.2% （157/165） with the operation time of （42.6± 20. 1 ） rain. The postoperative hemoglobin and hematocrit decline were observed in 69.7% （ 115/165 ） of the cases with the value of 2.67 g/L and 2.21% respectively when compared with their preoperative counterpart. Infection rate related to operation was 23. 03% （38/165）, which wasdemostrated by durative or iterative fever more than 48 hours. No perioperative bleeding was recorded, and no trans- fusion was required. No case experienced perirenal organ injury. Conclusions Using color doppler ultrasound guidance during m-PCNL resulted in safe and effective therapeutic method for upper urinary stone, and can be con- sidered as measures of choice for guidence of mPCNL in pediatric patients.
出处
《国际外科学杂志》
2012年第5期320-323,共4页
International Journal of Surgery
关键词
小儿结石
经皮肾镜碎石术
彩超
Pediatric urinary stones
Percutaneous nephrolithotomy
Doppler ultrasonography
