摘要
目的探讨超声引导经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)不逆行输尿管插管可行性与临床效果。方法2017年4月~2020年9月我院收治合并肾积水的上尿路结石42例,采用超声引导PCNL不逆行输尿管插管治疗。42例病人术中均未逆行输尿管插管,24例中重度肾积水病人直接在超声引导下穿刺目标肾盏穹隆,18例轻度肾积水病人静脉推注速尿40 mg行刺激性利尿,10分钟左右开始穿刺目标肾盏,建立取石通道,观察目标肾盏穿刺成功率、通道建立时间、手术时间、血红蛋白下降程度、一次性结石清除率、手术并发症等指标。结果42例病人均一次性穿刺成功,顺利建立皮肾通道实施PCNL。通道建立时间5~10分钟,平均(6.7±1.9)分钟,手术时间30~60分钟,平均(46.4±11.5)分钟,手术前后血红蛋白分别为(137.0±10.1)g/L、(132.7±12.3)g/L,差值为(5.6±5.2)g/L,一次性结石清除率为92.8%(39/42),未出现通道丢失、大出血、胸膜损伤、肠管损伤等并发症,无输血病例。结论在B超引导下,轻度肾积水通过刺激性利尿、中重度肾积水的肾输尿管结石病人不逆行输尿管插管实施PCNL安全可行,但需要良好的B超技术和丰富的经皮肾穿刺经验。
Objective To explore the feasibility and effect observation of non-retrograde ureteral catheterization in ultrasound guidedpercutaneous nephrolithotomy.Methods The clinical data of 42 cases of non-retrograde ureteral catheterization in ultrasound guided percutaneous nephrolithotomy in our hospital from April 2017 to September 2020 were retrospectively analyzed.None of the 42 patients underwent retrograde ureteral catheterization during surgery.24 patients with moderate to severe hydronephrosis were directly guided by ultrasound to puncture the target renal calyces fornix,and 18 patients with mild hydronephrosis,We were Intravenous infusion of furosemide 40 mg for irritating diuresis,about 10 minutes,we to puncture the target renalcalyces fornix,successful established a channel of percutaneous nephrolithotomy.Clinical data including The success rate of puncture the target renal calices,nephrostomy tract creation time,overall opration time,re-and postoperative hemoglobin value,the tone-free rateand complications were recorded and evaluated.Results All the 42 patients had successful one-time puncture successfully established skinto renal calyx channels,and performed percutaneous nephrolithotomy.Among mean tract creation time(6.7±1.9)min,overall operation time(46.4±11.5)min,re-and postoperative hemoglobin value was(137.0±10.1)g/L and(132.7±12.3)g/L,difference value was(5.6±5.2)g/L,the tone-free rate was 92.8%,no major complications,such as tract loss,massive bleeding,pleura and colon injure and transfusion cases.Conclusions Outcomes of clinical practice demonstrate that non-retrograde ureteral catheterization in ultrasound guided percutaneous nephrolithotomy is safe and efficacious abaut mild hydronephrosis is by stimulate diuretics and moderate to severe hydronephrosis renal ureteral calculi patients,but it must be accomplished by seasoned doctors and grasp certain ultrasound technology.
作者
谷炎
万水
刘国政
巩全华
GU Yan;WAN Shui;LIU Guozheng(Department of Urology,Traditional Chinese Medical Hospital of Wuhu,Anhui,Wuhu 241000,China)
出处
《临床外科杂志》
2021年第6期570-572,共3页
Journal of Clinical Surgery
关键词
经皮肾镜取石术
穿刺
刺激性利尿
不逆行输尿管插管
可行性
percutaneous nephrolithotomy
puncture
stimulate diuretics
no retrograde ureteral intubation
feasibility
