超声引导微通道经皮肾镜下碎石术的应用研究(附896例报告)

目的:探讨超声引导下行微通道经皮肾镜下碎石术(mini-PNL)治疗上尿路结石的可行性和优越性.方法:超声引导下行mini-PNL术共896例,其中肾鹿角形结石396例,肾盂结石350例,输尿管上端结石143例,移植肾结石7例.结果:896例患者中146例(16.3%)术前超声评估患肾积水较轻,而穿刺前输尿管插管,注生理盐水形成人工肾积水便于穿刺.872例(97.3%)患者1次穿刺成功,其余24例(2.7%)于一周后经第2次穿刺,22例成功,2例改行X线定位穿刺成功;碎石术中B超发现345例(38.5%)存在＞5 mm结石,在超声引导下定位并粉碎.术后每两周超声随访,1个月后,896例患者中823例(91.8%)结石完全清除,73例(8.2%)有残余小结石.并发症包括发热111例(12.3%),其中8例高热伴发菌血症败血症;出血138例(15.4%),其中2例发生下腔静脉损伤,但无严重出血发生;胸腔积液3例(0.3%);无腹腔内脏器损伤发生.结论:超声能对拟行mini-PNL术的病例作出准确判断,指导术前准备;术中超声引导可提高穿刺成功率,并有效避免血管及脏器损伤,避免大结石残留;术后可正确评估手术疗效.超声引导mini-PNL术治疗上尿路结石安全可行,适合在基层医院推广应用.

Experience of application of mini percutaneous nephrolithotomy under guidance of ultrasound

Objective:To evaluate the feasibility and availability of mini-percutaneous nephrolithotomy for upper urinary tract stones(mini-PNL) under quidance of ultrasound.Methods:896 patients were retrospectively investigated after treating with percutaneous nephrolithotomy under ultrasound guidance.Of these cases,staghorn calculi were found in 396 cases,renal pelvic calculi in 350,upper ureteral calculi in 143 and transplanted renal calculi in 7.Results:146 cases of 896 were found mild hydronephrosis with ultrasound preoperatively.Retrograde ureteral catheterization was performed for artificial hydronephrosis to make the puncture successful.During the operation,the residual calculi were detected over 5 mm in 345 cases,by ultrosound guidance to be crashed.The puncture succeeded by one pricking in 872 cases,and second pricking 1 week later in 24(including 2 cases by X-ray guidance).The total stone was cleared in 823 cases,and small stone remained in 73 cases.Complications:fever in 111 cases,including septicemia in 8 cases;hemorrhage in 138 cases,including vena cava inferior injury in 2 cases;pleural effusion in 3 cases;no abdominal organ injury.Conclusions:The ultrasound can decide the puncture position preoperatively,monitor the puncture process during the operation,and investigated the curative effect postoperatively.The perioperative application of ultrasound for percutaneous nephrolithotomy is effective and safe.