微创经皮肾穿刺钬激光碎石术心理状态及护理对策

复杂性肾结石是泌尿外科治疗的棘手难题.与传统开放性手术相比,经皮肾穿刺输尿管镜下钬激光碎石术具有创伤小、定位准确、术后恢复快等优点[1].肾结石患者术前、术后均存在复杂的心理问题.21207-03～2009-04采用B超引导下经皮肾微造瘘钬激光碎石术治疗复杂性.肾结石156例,我们对其进行心理调查及相对应的心理护理,效果满意,现报告如下.     

侧卧位单通道微创经皮肾镜取石术与输尿管软镜碎石术治疗成人肾结石临床效果比较

目的 比较侧卧位单通道微创经皮肾镜取石术(mPCNL)与输尿管软镜碎石术(RIRS)治疗成人肾结石的临床效果.方法 选取武汉大学同仁医院(武汉市第三医院)自2018年1月至2020年5月收治的120例成年肾结石患者为研究对象.将患者随机分入A组和B组,每组各60例.A组行mPCNL,B组行RIRS.比较两组的围术期指标...     

超声引导微创经皮肾镜取石术治疗复杂性肾结石98例

目的总结应用超声引导微创经皮肾镜取石术(MPCNL)治疗复杂性肾结石的临床经验。方法对98例复杂性肾结石患者施行超声引导MPCNL。结果98例中84例1次成功穿入肾盂,13例2次成功穿入肾盂,1例肾上盏结石穿刺不成功改行其他方法治疗。97例均行一期穿刺取石,其中1次取石成功68例(70.1%),需2次以上取石29例(29.9%)。单通道取石87例(89.7%),多通道取石10例(10.3%)。出院前复查X线片,肾盂结石及梗阻全部解除,遗留肾盏结石13例,结石清除率85.6%。结论B超引导MPCNL治疗复杂性肾结石是一种安全有效的方法。     

微创经皮肾镜钬激光碎石术治疗肾结石围手术期护理

目的:总结肾结石病人行微创经皮肾镜钬激光碎石术治疗肾结石围手术期护理。方法:2009-05～2011-12对60例肾结石患者行微创经皮肾镜钬激光碎石术,给予围手术期护理。结果:经严密护理,患者创伤小,出血少,术后恢复快,住院时间缩短。结论:术前进行卫生宣教及患者准备,术后做好一般护理,管道护理,加强并发症的观察与护理,重视出院指导是保障手术成功的重要环节。     

微创经皮肾镜取石术治疗开放手术后肾结石患者的临床疗效观察

目的观察微创经皮肾镜取石术(MPCNL)对开放手术后肾结石患者的临床疗效。方法对我院2009年1月—2013年6月收治的开放手术后肾结石患者56例进行MPCNL,并以同期初次行MPCNL患者50例作为对照,对两组患者手术情况、术后并发症和结石清除率进行比较。结果两组患者手术时间、术中出血量比较差异无统计学意义(P>0.05);住院时间观察组多于对照组,差异有统计学意义(P<0.05);观察组结石清除率88.79%,对照组90.64%,差异无统计学意义(P>0.05),两组未清除结石均为鹿角型或多发性结石;观察组并发症发生率16.07%,对照组14.00%,两组比较差异无统计学意义(P>0.05)。结论 MPCNL对开放手术后肾结石患者治疗与初次结石治疗并无明显区别,MPCNL是治疗肾结石的有效方法。     

CT定位经皮肾镜取石术治疗肾结石的效果分析

目的 探究CT定位经皮肾镜取石术对肾结石的疗效.方法 选取64例经皮肾镜取石术者分为两组,对照组接受B超定位穿刺,观察组接受CT定位穿刺.结果 观察组血流速度,手术时间予血红蛋白损伤,优于对照组;对照组结石清除率小于观察组(56.25% VS 81.25%);观察组的并发症发生率小于对照组(9.38% VS 25%),(P<0.05).结论 CT定位穿刺可以为经皮肾镜取石术提供精准的路径,可使手术时间缩短,降低术中出血量,促进结石清除率显著提高.     

超声引导微创经皮肾镜气压弹道碎石术治疗肾结石

经皮肾镜肾结石碎石取石术对患者创伤小,痛苦少,出血少,结石取净率高,能保存或改善肾功能,是现代治疗肾结石重要方法之一。2006-12~2009-01我院采用B超引导下经皮肾镜气压弹道碎石术治疗复杂肾结石123例效果满意,报告如下。     

B超引导下经皮肾镜钬激光联合超声碎石清石术治疗上尿路结石

目的探讨B超引导下经皮肾镜钬激光联合超声碎石清石术治疗上尿路结石的安全性和有效性。方法上尿路结石患者376例,其中肾结石患者287例,输尿管上段结石65例。结石最大径0.8～7.5 cm。B超引导下经皮肾穿刺,建立F20工作通道,使用钬激光联合第四代EMS超声碎石清石系统治疗。总结分析手术方法、手术时间、结石清除率及并发症等。结果 376例患者B超引导下1次穿刺成功建立经皮通道,5例因穿刺或扩张时出血明显,及时终止手术。碎石清石总成功率为93.6%(352/376)。287例肾结石患者一期结石清除率为70.0%(201/287),65例输尿管上段结石患者一期结石清除率为95.4(62/65)。二期碎石48例,残留结石最大径0.5～1.0 cm。23例患者行体外震波碎石治疗,残留结石最大径≤0.4 cm。23例患者经体位排石等保守治疗排净。平均手术时间(110.5±28.6)min,术中平均出血量(104±37.2)ml;输血5例。肾造瘘管留置时间平均8 d,术后平均住院时间9 d。大出血3例行选择性肾动脉栓塞治疗后痊愈;术后气胸1例行胸腔闭式引流后痊愈;术后肾周巨大血肿1例,行保守治疗后好转。术后低、中度发热者31例,高热者5例。结论 B超引导下经皮肾镜钬激光联合第四代EMS碎石清石系统治疗上尿路结石创伤小、恢复快、安全高效、并发症少,疗效可靠,是治疗上尿路结石的优先选择。     

输尿管软镜钬激光碎石术治疗肾结石52例

目的：探讨输尿管软镜钬激光碎石术治疗肾结石的疗效及安全性。 方法：2013年5月至2014年4月,肾结石52例,男性45例,女性7例。左肾结石27例,右肾结石25例,结石位于肾盂7例,肾中盏6例,下盏32例,多肾盏结石7例。     

超声引导微创经皮肾镜钬激光治疗复杂性肾结石

目的 探讨超声引导微创经皮肾镜钬激光碎石术治疗复杂性肾结石的治疗效果.方法 使用超声引导微创经皮肾镜钬激光治疗复杂性肾结石121例,超声引导经皮肾镜气压弹道碎石术治疗复杂性肾结石82例,比较碎石率、结石取净率和术后严重并发症.结果 超声引导微创经皮肾镜钬激光纽碎石率一期为95.8%,二期为96.0%;结石取净率-期为89.6%,二期为92.0%;术后严重并发症3.3%;超声引导经皮肾镜气压弹道组碎石率-期为83.9%,二期为85.0%;结石取净率一期为74.2%,二期为80.0%;术后严重并发症3.7%.结论 超卢引导微创经皮肾镜钬激光治疗复杂性肾结石疗效明显优于气压弹道碎石,是治疗复杂肾结石的一种安全、有效的方法.     

经皮肾穿刺碎石术出血原因及防治

目的：探讨经皮肾穿刺碎石术出血原因及防治措施。方法：回顾分析我科2009-04-2011-04行经皮肾穿刺碎石术出血患者15例,其中11例为术中出血,4例为术后继发性出血。结果：8例因术中出血较多而终止手术,给予保守处理;2例因穿刺过深,中转行开放手术;1例损伤叶间动脉,选择性栓塞后二期ESWL处理;1例术后病人为假性动脉瘤,行肾动脉介入手术;3例PCNL后发现肾周血肿,二期行血肿清除术;15例患者均全愈出院。结论：经皮肾穿刺碎石术出血应根据不同的出血原因选择不同的处理方式,特别是对PCNL开展时间尚短的医院更应在PCNL出血较多时及时终止手术,保证安全前提下行二期清石。     

微创经皮肾镜钬激光碎石术治疗肾结石及输尿管上段结石——附708例报告

目的探讨微创经皮肾镜钬激光碎石术治疗肾结石及输尿管上段结石的有效性、优越性和安全性。方法采用微创经皮肾镜钬激光碎石术治疗肾结石及输尿管上段结石708例,经皮肾扩张后置入鞘,采用输尿管镜直视下配合钬激光将结石粉碎,一次或分次清除结石。结果所有结石患者手术均获成功,无1例中转开放手术,成功率100%。430例肾结石（其中双肾结石87例）,一次取净结石145例,二次取净结石218例,3次取净结石21例,四次取净结石7例,结石总取净率91%,肾盂梗阻解除率100%。198例输尿管上段结石均一次取净结石（其中双侧输尿管结石23例）,总取净率100%。肾结石并输尿管结石80例,结石总取净率94%。手术时间15～128 min,平均73 min。无术中输血及肾盂输尿管穿孔。结论微创经皮肾镜钬激光碎石术治疗肾结石及输尿管上段结石具有碎石效率高、创伤小、疗效可靠、安全性高、治疗时间较短等优点,适合推广应用。     

超声引导微创经皮肾镜钬激光碎石联合肾盏憩室颈切开治疗肾盏憩室结石

目的探讨微创经皮肾镜钬激光碎石联合肾盏憩室颈切开治疗肾盏憩室结石的临床疗效。方法回顾分析我院采用微创经皮肾镜钬激光碎石联合肾盏憩室颈部狭窄切开治疗22例肾盏憩室结石患者的临床资料,总结肾盏憩室结石微创治疗的经验和对策。本组患者女性10例,男性12例;平均年龄35.6岁。其中肾上盏憩室结石10例,肾中盏憩室结石5例,肾结石合并肾盏憩室结石7例。采用B超定位引导直接穿刺结石所在之肾盏憩室,应用钬激光碎石,同时以钬激光切开憩室颈部狭窄。结果7例肾结石合并肾盏憩室结石患者中,5例行一期双通道取石,2例行二期经皮肾镜取石;余15例患者均一期微创经皮肾镜成功取石。术后复查22例均无结石残留。手术时间为25～120min,平均45min;术中出血15～80ml,平均35ml。无术后严重并发症发生,无中转开放手术病例,术后7～12d出院。结论微创经皮肾镜钬激光碎石创伤小,清除结石的同时可以应用钬激光行肾盏憩室颈部狭窄的切开,为有症状的肾盏憩室结石患者提供一种微创治疗的选择。     

微创腔镜技术治疗结石性脓肾46例疗效分析

目的探讨用微创腔镜技术治疗结石性脓肾的疗效。方法结石性脓肾患者46例,其中32例采用微创经皮肾镜取石术,11例采用经尿道输尿管镜取石术,3例同时采用微创经皮肾镜取石和经尿道输尿管镜取石术治疗。结果术后40例获得随访6个月。5年,患肾功能恢复或部分恢复31例（77．5％）,患肾萎缩（无功能）7例（17．5％）,患肾切除2例（5％）。结论腔镜技术治疗结石性脓。肾是安全、有效的;早期诊断、及时引流、解除梗阻是结石性脓肾保肾治疗的关键。     

Urolithiasis in a children’s hospital: 1985–1990

We performed a retrospective study of patients who had urinary tract stones and were seen at our hospital from 1985–1990. The study was intended to determine the prevalence of urolithiasis and optimal approaches to imaging. Clinical data and imaging studies of 87 patients were reviewed. The mean age was 15.7 years with a range of 3 months to 44 years. Fifty-four percent of patients were male. Most patients had a known predisposing cause for urolithiasis; patients with myelodysplasia and structural urologic problems predominated. Plain films were performed in 77 patients; 57% showed stones. Ultrasonograms were performed in 71 patients; 77% showed stones. Excretory urograms (EU) were performed in 49 patients; 84% showed either stones or their effect on the urinary tract. Computed tomographic (CT) scan was performed in 25 patients; all showed stones.     

Percutaneous sclerotherapy of a symptomatic simple renal cyst in a child: observation of membrane detachment sign

A 6-year-old girl with 21 sy mptomatic renal cyst underwent successful percutaneous aspiration and sclerotherapy with hypertnic saline under US guidance. Although membrane detachment sign was seen clearly during aspira tion, it was confirmed to he a simple cyst. In contrast to prey ious reports, membrane detachment sign is not pathognomonic for hydatid and may be seen after simple cyst aspiraion. Therefore differntiation of a symptomatic renal cyst from a hydatid cyst should not depend solely on membrane detachmentIn either case US- or CT-guided percutatneous sclerotherapy should always be considered before surgery.     

Percutaneous nephrostomy in pyonephrosis

A series of 76 pyonephrotic kidneys in 73 patients were drained by percutaneous nephrostomy (PN) tube and examined to evaluate the contribution of this technique to the treatment of pyonephrosis. In 71 patients, clinical symptoms disappeared 24–48 h after the procedure. Two patients died from sepsis subsequent to anuria and underlying malignancy. Once the acute phase had remitted, interventional procedures were carried out in 39 cases, and constituted the definitive therapy in 36. In 32 cases, elective surgery was the definitive therapy, including the 3 cases not resolved after interventional procedures. Three patients in whom the obstruction cleared spontaneously following PN needed no additional treatment. Major complications included 6 cases of sepsis, all of which resolved satisfactorily with proper medical therapy.     

Removal of a Trapped Endoscopic Catheter from the Gallbladder via Percutaneous Transhepatic Cholecystostomy: Technical Innovation

Background Percutaneous cholecystostomy is used for a variety of clinical problems. Methods Percutaneous cholecystostomy was utilized in a novel setting to resolve a problematic endoscopic situation. Observations Percutaneous cholecystostomy permitted successful removal of a broken and trapped endoscopic biliary catheter, in addition to helping treat cholecystitis. Conclusion Another valuable use of percutaneous cholecystostomy is demonstrated, as well as emphasizing the importance of the interplay between endoscopists and interventional radiologists.