超声引导在经皮肾镜治疗肾及输尿管上段结石术中的应用价值探讨

目的评价超声引导在微创经皮肾镜取石术治疗。肾结石和输尿管上段结石中的应用价值：方法451例肾或输尿管上段结石患者，采用超声引导定位下肾穿刺，建立皮肾通道；碎石取石过程中超声监测有无结石残留并指导啐石取石；必要时超声引导下建立多个皮肾通道取石？结果450例患者在超声引导下成功建立了皮肾通道，1例超声引导穿刺失败。超声引导下穿刺成功率为99．8％（450／451），其中402例患者经超声引导一次性穿刺成功，48例患者两次穿刺成功；82例患者超声引导下建立多个皮肾通道。结论微创经皮肾镜取石术采用超声引导定位穿刺建立皮肾通道，具有定位准确、安全、可重复、简便易行及避免放射线损伤等优点，可作为经皮肾镜引导穿刺的首选方法。

Application value of ultrasound-guided percutaneous nephrolithotomy in treatment of renal and upper ureteral calculi

Objective To evaluate the application value of minimally invasive percutaneous nephrolithotomy （MPCNL） under ultrasound guidance in the treatment of renal and upper ureteral calculi. Methods Four hundred and fifty-one patients with renal and upper ureteral calculi were enrolled in this study. Renal puncturation was performed under ultrasound loeatization, and skin to kidney accesses was established. The ultrasound was also used to find whether there were residual stones and to establish more skin to kidney accesses if necessary. Results The skin to kidney accesses were established successfully under ultrasound guidance in 450 patients,1 ease was failed, and the achievement ratio was 99.8% （450/451）. 402 patients were punctured successfully under ultrasound guidance at the first time, and 48 patients were successtul at the second time. More than one access were established in 82 patients under ultrasound guidance. Conclusion Ultrasound-guided skin to kidney access establishment has the advantage of accuracy, safety, repeatability, feasibility and fi＇ee of radiation damage. It might be the first choice for the establishment of skin to kidney access in MPCNL.