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INTRODUCTION: To assess the efficacy, safety and morbidity of tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS: One hundred and fifty-two patients with renal and upper ureteric calculi were included in this study. Sixty-nine patients (71 renal units; group 1) in whom no nephrostomy tube was placed at the conclusion of the procedure was compared with a similar control group of 83 patients (group 2) in whom a nephrostomy tube was placed. Operating time, blood loss, analgesia requirement, puncture site urinary leakage, hospital stay and mean convalescence period were compared in both groups. RESULTS: Both groups were similar with respect to age, sex distribution and stone size. Operating time and blood loss were less in group 1 although they did not reach statistical significance. The mean analgesic requirement, puncture site urinary leakage and hospital stay were significantly less in group 1. CONCLUSION: Tubeless percutaneous nephrolithotomy is a safe and effective procedure in this selected group of patients. 相似文献
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随着手术设备的更新以及经验的积累,经皮肾镜取石术日趋成熟,尽管也存在一些争议,但很多方面已基本达成了共识。俯卧位下X线定位穿刺,建立F18~F24通道,运用气压弹道、钬激光、超声碎石等工具综合清理结石构成经典的经皮肾镜取石术(PCNL),但微通道经皮肾镜取石术(ultra-mini PCNL)、无管化经皮肾镜取石术(tubeless PCNL)等技术的发展也有一定的临床应用前景。不论如何,采用科学的态度,遵循基本操作原则,才能保证PCNL手术的安全有效。 相似文献
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微创经皮肾镜取石术对肾血流动力学的影响 总被引:5,自引:0,他引:5
目的探讨微创经皮肾镜取石术(MPCNL)穿刺通道数量对肾内血流动力学的影响。方法应用彩色多普勒血流显像连续观察74例单侧肾结石患者MPCNL术前及术后1个月肾脏血流动力学变化,对比分析单通道取石(57例)、双通道取石(10例)患者及多通道取石(7例)3组肾内肾辛动脉、段间动脉、叶间动脉收缩期间峰值流速(Vmax)及收缩期峰值流速(S)与舒张期末流速(D)的比值(S/D)和阻力指数(resistant index,RI)。结果术前、术后1个月3组肾主动脉Vmax、S/D、R1值比较,差异均无统计学意义(P值均〉0.05);3组肾段间动脉Vmax、S/D、R1值比较,单、双通道取石组P值均〉0.05,多通道取石组P值均〈0.05,术后肾内血流较术前明显减少;3组肾叶间动脉Vmax、S/D、RI值比较,P值均〈0.05,单通道、双通道MPCNL术后肾内血流动力学指标明显改善,多通道MPXNL术后肾内血流较术前明显减少。结论单通道、双通道MPCNL能明显改善术后肾脏血流灌注,多通道MPCNL对术后肾脏血流灌注有不利影响。 相似文献
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Infundibular stenosis after percutaneous nephrolithotomy. 总被引:1,自引:0,他引:1
J Kellogg Parsons Thomas W Jarrett Vanessa Lancini Louis R Kavoussi 《The Journal of urology》2002,167(1):35-38
PURPOSE: Acquired infundibular stenosis can develop after percutaneous nephrolithotomy. We review our experience with infundibular stenosis after this procedure. MATERIALS AND METHODS: We evaluated the records of patients diagnosed with infundibular stenosis after percutaneous nephrolithotomy was performed at our institution between 1995 and 2000. Analysis included medical history, urinary stone type, stone removal procedure technique, length and number, postoperative course, stenosis time to development location, severity and treatment, and treatment outcome. RESULTS: Infundibular stenosis developed in 5 of 223 percutaneous nephrolithotomy cases (2%) performed during this period. Medical history in affected patients included previous ipsilateral open pyelolithotomy, diabetes and morbid obesity in 2 each. Percutaneous nephrolithotomy were done through a standard 30Fr nephrostomy tract and all cases were terminated before complete stone removal. Mean operative time was 258 minutes, which was significantly greater than the mean operative time of 207 minutes in all cases of unilateral percutaneous nephrolithotomy (p = 0.03). Postoperatively nephrostomy tube drainage was done for a mean of 33 days (range 16 to 51). All patients underwent at least 1 additional percutaneous stone removal procedure after primary percutaneous nephrolithotomy and before stenosis was detected. The mean time to stenosis detection was 9 months (range 2 to 24). Stenosis generally developed in areas corresponding to previous sites of percutaneous access and the degree of narrowing ranged from mild to severe. Mild and moderate stenosis was managed by observation and endoscopic dilation in 2 each. Severe stenosis in 1 patient was associated with significantly impaired ipsilateral renal function. CONCLUSIONS: Infundibular stenosis is a rare complication of percutaneous nephrolithotomy. In this series it was associated with prolonged operative time, a large stone burden requiring multiple removal procedures and extended postoperative nephrostomy tube drainage. In most cases stenosis developed at previous access sites within 1 year of initial percutaneous nephrolithotomy. Mild and moderate cases may be treated with observation and endoscopic dilation, respectively, while severe cases may result in renal impairment. 相似文献
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目的 经皮肾镜碎石术(percutaneous nephrolithotomy,PNL)是治疗肾结石的首选治疗方案,本研究旨在探讨一种合适的经皮肾镜碎石术方案,以提高肾结石及输尿管上段结石的治愈率.方法 回顾性分析676例肾结石及输尿管上段结石患者的临床资料,分析患者全身情况、结石特点及局部解剖结构等特点与成功穿刺碎石的相关性.结果 所有患者均成功穿刺成功,676例患者共行经皮肾镜碎石术1557例次,最终净石率84.8%.术中术后并发症主要是出血,术中术后接受输血患者17例,其中8例行选择性肾动脉栓塞治疗.感染性休克2例,胸腔积液2例,无肠道、肝脏等腹腔脏器损伤.结论 并非所有患者同一化穿刺方案行经皮肾镜碎石取石术,应该个体化对待. 相似文献
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Kang DE Maloney MM Haleblian GE Springhart WP Honeycutt EF Eisenstein EL Marguet CG Preminger GM 《The Journal of urology》2007,177(5):1785-8; discussion 1788-9
PURPOSE: Percutaneous nephrolithotomy is a commonly used procedure for treatment of large or complex renal calculi. In some instances postoperative residual stone fragments are an unavoidable result. Yet to our knowledge no study has examined the impact of medical management on stone formation in patients with or without residual fragments following percutaneous nephrolithotomy. Thus, we have conducted the first investigation of aggressive medical management following percutaneous nephrolithotomy and its impact on stone formation rates in patients with and without residual fragments. MATERIALS AND METHODS: A total of 70 patients who underwent percutaneous nephrolithotomy and received counseling regarding selective medical management following a comprehensive metabolic evaluation, were identified. Patients were placed into 4 groups following percutaneous nephrolithotomy, that is stone-free or residual fragments, who underwent or did not undergo medical therapy. New stone formation was assessed by spontaneous stone passage in the absence of residual stone fragments, stone passage without change in the number of residual fragments, surgical removal of newly formed stones, or appearance of new stones or increase in size of stone or fragments on abdominal radiographs. Stone remission rates were also calculated. RESULTS: Selective medical therapy significantly decreased stone formation rates in the stone-free (0.67 stones per patient per year vs 0.02) and residual fragment groups (0.67 stones per patient per year vs 0.02) as determined by the Wilcoxon signed rank test (p<0.0001). Moreover, remission was observed in a higher proportion of patients in the medically treated stone-free and residual fragment groups (87% and 77%) when compared to the same groups without medical therapy (29% and 21%, chi-square test p<0.0001). CONCLUSIONS: Our findings suggest that comprehensive metabolic evaluation and aggressive medical management can control active stone formation and growth in patients with or without residual stone fragments after percutaneous nephrolithotomy. Given the inherent morbidity and increased costs attendant with repeat procedures, medical management should be instituted in patients following percutaneous nephrolithotomy without regard to stone-free status. 相似文献
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Tubeless percutaneous nephrolithotomy in selected patients. 总被引:6,自引:0,他引:6
B Lojanapiwat S Soonthornphan S Wudhikarn 《Journal of endourology / Endourological Society》2001,15(7):711-713
BACKGROUND: Placement of the nephrostomy tube is the last step after completion of percutaneous nephrolithotomy (PCNL). We were able to demonstrate in selected patients who had undergone PCNL that the use of an externalized ureteral catheter can reduce postoperative discomfort without complications. PATIENTS AND METHODS: A total of 37 patients underwent tubeless PCNL with an externalized 6F ureteral catheter for 48 hours. Inclusion criteria were use of a single access site where the renal unit was not obstructive, no significant perforation and bleeding, and no need for a second look. The stone burden was not taken into account. RESULTS: The procedure was performed successfully without major complications. The average length of hospitalization was 3.63 days: 25 patients stayed for 4 days, with the final day reserved for observation after removal of the catheter. The remaining 12 patients stayed only 3 days and could be discharged on the day the catheter was removed. The average intramuscular analgesic requirement was 38.57 mg of meperidine, and none of the patients needed a blood transfusion or required the emergency placement of a nephrostomy tube. CONCLUSION: In properly selected patients, tubeless PCNL with only an externalized ureteral catheter was found to be safe and just as economical as tubeless PCNL with the same outcome. 相似文献
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同期双侧经皮肾镜碎石术的安全性及疗效分析 总被引:1,自引:0,他引:1
目的 探讨同期双侧经皮肾镜碎石术的安全性及疗效. 方法 双侧肾结石或输尿管上段结石48例.其中双侧肾结石26例、一侧肾结石并发对侧输尿管结石9例、双侧输尿管上段结石5例、双侧肾结石并发一侧输尿管结石8例.结石直径1.0~7.5 cm,平均2.9 cm.其中鹿角形结石28例.患者术前血红蛋白平均(126±13)g/L,伴肾功能不全13例,SCr 188~805/μmol/L,术前透析3例.采用B超引导经皮肾镜下气压弹道联合超声碎石,双侧同期治疗.分析手术时间、失血量、输血率、住院时间、结石清除率及并发症发生情况. 结果 48例96侧均一期成功建立皮肾通路,43例双侧行一期碎石,其中4例一侧行2通道碎石;5例第二侧行二期碎石.平均手术时间(105±18)min.术后患者血红蛋白较术前平均下降21 g/L,输血5例.术后平均住院时间6.5 d.一期结石清除率77.1%(37/48),总结石清除率87.5%(42/48),4例较大残余结石者辅以ESWL治疗.无严重并发症发生. 结论 同期经皮肾镜碎石术治疗双侧肾结石或输尿管上段结石安全可行,但对肾功能差、结石负荷过大者慎行. 相似文献
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OBJECTIVE: This review focuses on a step-by-step approach to percutaneous nephrolithotomy (PNL) and its complications and management. METHODS: Based on institutional and personal experience with >1000 patients treated by PNL, we reviewed the literature (Pubmed search) focusing on technique, type, and incidence of complications of the procedure. RESULTS: Complications during or after PNL may be present with an overall complication rate of up to 83%, including extravasation (7.2%), transfusion (11.2-17.5%), and fever (21.0-32.1%), whereas major complications, such as septicaemia (0.3-4.7%) and colonic (0.2-0.8%) or pleural injury (0.0-3.1%) are rare. Comorbidity (i.e., renal insufficiency, diabetes, gross obesity, pulmonary disease) increases the risk of complications. Most complications (i.e., bleeding, extravasation, fever) can be managed conservatively or minimally invasively (i.e., pleural drain, superselective renal embolisation) if recognised early. CONCLUSIONS: The most important consideration for achieving consistently successful outcomes in PNL with minimal major complications is the correct selection of patients. A well-standardised technique and postoperative follow-up are mandatory for early detection of complications. 相似文献
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We report the unusual complication of severe pancreatitis following an uneventful percutaneous nephrolithotomy. We discuss its diagnosis and treatment. 相似文献
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Totally tubeless percutaneous nephrolithotomy 总被引:3,自引:0,他引:3
PURPOSE: We evaluated the requirement for routine placement of a ureteral stent and a nephrostomy tube following percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A total of 43 patients underwent totally tubeless PCNL and was compared with a control group of 43 age-, sex-, weight-, and procedure-matched patients who had previously undergone PCNL with placement of a ureteral stent and a nephrostomy tube. Exclusion criteria for the tubeless approach were more than two percutaneous accesses, significant perforation of the collecting system, a large residual stone burden, significant postoperative bleeding, ureteral obstruction, and renal anomaly. The incidence of complications, length of hospitalization, analgesia requirements, and interval to return to normal activities were compared in the two groups. RESULTS: All 43 percutaneous procedures were performed without significant complications. None of the patients demonstrated urinoma in postoperative renal ultrasound scans. The average length of hospital stay was 1.6 days, with two-thirds of the patients staying <1 day for the study group, and 5.2 days for the controls (P < 0.001). The average analgesia requirement was 9.8 mg and 28.4 mg of morphine, respectively (P < 0.001). Patients returned to normal activities with 12.7 days v 24.6 days for the controls (P < 0.001). CONCLUSION: Totally tubeless PCNL is a safe and effective procedure. The hospitalization and analgesia requirements are less and the return to normal activities faster with this technique. 相似文献
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D. Ozkan T. Akkaya N. Karakoyunlu E. Arık J. Ergil Z. Koc H. Gumus H. Ersoy 《Der Anaesthesist》2013,62(12):988-994