摘要
目的 探讨无穿刺架超声引导经皮肾镜钬激光或EMS4代取石术治疗上尿路结石的可行性.方法 选取2011年7月～2013年8月采用无穿刺架超声引导经皮肾镜钬激光或EMS4代取石术治疗34例上尿路结石.其中肾结石25例,输尿管上段结石5例,肾结石并输尿管上段结石4例.输尿管上段结石直径0.7 ～2.4cm,平均1.6cm;肾结石直径1.5～4.3cm,平均2.3cm.在肩胛下角线、腋后线第11肋间或第12肋下区域,用无穿刺架的超声探头广泛检查肾脏各切面,确定皮穿刺点、目标肾盏以及穿刺角度和深度.依据皮肤穿刺点,选择在探头上下方沿探头面纵轴线或探头内外侧中点处穿刺,在超声引导下将18G针穿刺目标肾盏,建立F16、F18或F24通道.F8/9.8输尿管镜下钬激光或EMS4代取石.结果 所有患者成功建立F16 ～24通道并进行钬激光或EMS4代取石,为单通道或双通道.手术时间27 ～ 185min,平均88min,出血20 ～ 600mL,平均58mL.30例Ⅰ期碎石成功,4例因术中出血和肾周积液,于术后4～7d行Ⅱ期取石.术后4周复查KUB及超声,结石排净率88.2％（30/34）.未出现严重出血、液气胸、腹腔脏器损伤等并发症.结论 无穿刺架超声引导经皮肾镜钬激光或EMS4代取石术治疗上尿路结石定位准确,安全有效.
Objectives To discuss the feasibility of ultrasound-guided minimally invasive percutaneous nephrohthotomy（PCNL） without using a puncture needle holder for renal and upper ureteral stones.Methods From July 2011 to August 2013,weperformed PCNL under the guidance by ultrasonography without a puncture needle holder on 34 patients with upper urinary calculi.Among the cases,25 patients had renal stones,5 patients had upper ureteral stones,and 4 had renal stones complicated with ipsilateralupper ureteral stones.The size of the upper ureteral stones ranged from 0.7 to 2.4cm with a mean of 1.7 cm in diameter,and that of the renal stones ranged from 1.5 to 4.3 cm with a mean of 2.3 cm.To determine the target renal calices,and site,angle and depth of puncture,between the infrascapular and posterior axillary lines,at the 11th intercostal region or below the 12th rib,we crisscrossedlydetected the kidney with an ultrasound probe.With the probe in left hand and a puncture needle in the right hand,under the guidanceby ultrasonography,we inserted an 18-G puncture needle into the target renalcalices,so that to build a F16--F18 orF24 channel.Afterwards,holmium laser lithotripsy was carried out under a F9.8ureteroscope.Results Single F16 ～ 18 or F24 Channel was established in all the patients,and holmium laser lithotripsy was completed within a mean of 88 minutes （ranged from 27 to 185 minutes）.The mean intraoperative blood loss was 58 ml （ranged from 20 to 600 nil）.Thelithotripsy was succeeded in 30 of the patients in one session,and the other four received a second lithotripsy in 4 to 7 days after the firstsession because of intraoperative hemorrhage or perirenal effusion.Postoperative examination by KUB and ultrasonography showed thatthe stone clearance rate was 882％ （30/34）.No patients had massive hemorrmge,hydropneumothorax or injuries to the abdominalorgans.Conclusions It is safe,feasible and effective to perfrom PCNL under ultrasound guidance without using puncture needleholder.The approach is accurate in positioning upper urinary stones.
出处
《国际泌尿系统杂志》
2014年第3期322-324,共3页
International Journal of Urology and Nephrology
关键词
尿路结石
碎石术
激光
激光
固体
Urinary Calculi
Lithotripsy, Lasers
Lasers, Solid-State
