微创经皮肾输尿管镜治疗上尿路结石穿刺定位技术的探讨

目的：测量在不同体位下用微创经皮肾造口输尿管镜治疗上尿路结石（MPCNL）术中定位穿刺位点的位置，明确穿刺位点在不同体位时的变化，量化穿刺位点变化范围；探讨B超和X线两种定位方法同分次手术和并发症之间的联系。方法：2002年11月～2006年4月间，因上尿路结石接受MPCNL治疗患者共计180例，测量穿刺位点同各标志线的距离并对穿刺点变化范围进行检验；对两种方法引导定位的耗时和对手术的影响进行统计分析。结果：手术穿刺区域在侧卧住时向上移动约2cm（P〈0．001），同时向外侧移动约0．5cm（P〈0．05）。B超引导定位平均耗时为32．34min，X线引导定位平均时间为14．29min，分次手术共计33例，占18．33％，主要分布于穿刺定位时间长的手术中。结论：为避免血管损伤，体表穿刺的位点随手术体位的不同而应该作相应的调整，侧卧位时穿刺区域应该上移并外展；分次手术为18．33％，如增加穿刺定位耗时，不耐受性导致分次手术机会增加。

Technique of Puncture Location in Treating the Upper Urinary Track Calculus with Mini-percutaneous Nephrolithotomy

Objective:To showcase the changing range of puncture positions by measuring the puncture points in patients who used dissimilar poses to be treated by mini-percutaneous nephrolithotomy. To discuss the relationship of complication and location with channeling off by different methods:B-type ultrasound and X-ray. Methods:All of the 180 patients were treated with MPCNL because of the upper urinary track calculus in our hospital from 2002.11 to 2006. 04. Measure the distance from each puncture point to every sign position of the body and check the changing range. Analysising the infection to the operation with channeling off by different methods:B-type ultrasound and X-ray. Results: Comparing the prone position, the whole areas would be moved up about 2 cm(P<0.001) and be moved outside about 0. 5 cm(P<0. 05) when we gave the patients lateral position.The average time of puncture channeling off with B-type ultrasound is 32. 34 minutes compared X-ray is 14. 29 minutes. 33 patients(18.33%) got the repetitious operations and they were primarily distributed in the patients with long-time puncture. Conclusion:The puncture areas would be changed and modulated following the patients' poses in operations. Comparing the prone position, the whole areas would be moved up and outside when we used lateral position.The rate of repetitious operations was 18.33%. If the puncture time was added,the repetitious operative risks will be raised.