超声造影剂辅助经皮肾穿刺技术处理无积水肾肾结石的单中心临床研究

目的 探讨逆行腔内注射超声造影剂辅助超声引导下经皮肾穿刺技术处理无积水肾合并肾结石的可行性及安全性。方法 选取鄂东医疗集团市中心医院2014年1月至2016年8月行逆行输尿管注射超声造影剂辅助超声引导下经皮肾镜取石术（PCNL）的60例肾结石患者。右肾结石患者25例；左肾结石患者35例。肾结石位于肾盂或者肾盏。术中通过同侧输尿管导管逆行注射超声造影剂，比较单纯B型超声成像与造影剂增强下超声成像模式，选择合适的穿刺通道，记录患者术前一般情况、手术时间、穿刺时间、平均出血量、平均住院时间及术后结石清除率。结果 患者的结石直径为（24.5±12.0）mm，在B超辅助下，穿刺时间为（55.4±44.8）s,一针穿刺成功率为98.3%（59/60）。所有PCNL顺利完成，术中出血量80～100 mL;术后住院时间7～10 d，平均8 d；术后结石清除率为98%。无术中并发症，无超声造影剂注射发生不良事件等。结论 PCNL术中逆行超声注入造影剂可以作为肾穿刺辅助手术。通过改善集合系统的可视化，有助于精准穿刺无积水的目标肾盏，值得临床推广。

Feasibility of retrograde ureteral contrast injection to guide ultrasonographic percutaneous renal access in the nondilated collecting system

Objective   To investigate the feasibility and safety of retrograde ureteral injection of ultrasonic contrast agent assisted ultrasound guided percutaneous renal puncture technique in treatment of unhydrated kidney combined with renal calculi.Methods   Sixty patients with kidney stones who underwent retrograde ureteral injection assisted by ultrasound contrast agent and ultrasound-guided percutaneous nephrostolith (PCNL) were selected from Huangshi central hospital of Edong health care group from January 2014 to August 2016. There were 25 cases of right kidney stones, 35 cases of left kidney stones. Kidney stones were located in the renal pelvis or calculi. During the operation, ultrasound contrast agent was injected retrograde through ipsilateral ureteral catheter to compare the ultrasound imaging mode with ultrasound imaging mode enhanced with contrast agent. The appropriate puncture channel was selected and the preoperative general situation, operation time, puncture time, average blood loss, average length of hospital stay and postoperative stone clearance rate of the patients were recorded.Results   The patient's stone diameter was (24.5±12.0)mm, and the puncture time was (55.4±44.8)s with the help of B-ultrasound. The success rate of one needle puncture was 98.3%. All PCNL were successfully completed, and the intraoperative blood loss was 80～100 mL. The postoperative hospital stay was 7～10 d, 8 d on average. The postoperative calculi clearance rate was 98%. There were no intraoperative complications and no adverse events occurred by ultrasound contrast agent injection.Conclusions   Retrograde ultrasound injection of contrast agent during PCNL can be used as an auxiliary renal puncture operation. By improving the visualization of the collection system, it is helpful to accurately puncture the target calyces without hydrocephalus, which is worthy of clinical promotion.