导丝及穿刺针在经皮肾镜碎石术中的新应用

目的 探讨导丝及穿刺针在经皮肾镜手术中提高一次结石清除率的临床疗效.方法 2008年10月至2009年10月本科收治的鹿角型结石患者中,有19例患者使用导丝及穿刺针来提高结石清除率,其中男性11例,女性8例,平均年龄42.8岁.左侧10例,右侧9例,术前行CT、肾盂分泌造影等检查明确诊断.患者均给予全身麻醉,穿刺点选择在第12肋缘下、腋后线与肩胛下线之间区域,超声引导下用18G穿刺针进行穿刺,穿刺成功后经穿刺针留置导丝,扩张穿刺通道至F18后,留置Peel-away鞘,置入肾镜,用钬激光将视野所能见结石击碎,并将结石碎块冲出体外.如X线或超声检查证实有肾盏结石残留,保留原穿刺通道,超声引导下经有残余结石的肾盏进行穿刺,穿刺成功后将导丝置入肾盂,X线片证实导丝位于肾盂内,经第1个穿刺通道进境寻找导丝,沿导丝寻找肾盏内结石,必要时行肾盏颈口劈开.如因角度问题,沿导丝无法探及结石,撤出导丝,超声引导下用穿刺针直接穿到结石表面,并稍用力将肾盏内结石推入肾盂内进行碎石.结果 2例肾盏颈口较窄,行两通道碎石,其余17例均碎石成功,结石一次性完全清除,平均手术时间83.2 min,术中估计出血量100 ml,术后下床活动时间14.6 d,术后住院5.8 d.3例患者术后出现发热,无尿瘘、胸膜损伤、大出血等并发症出现.结论 经皮肾镜手术中导丝及穿刺针的新应用,可显著提高一次结石清除率,尤其对于复杂性鹿角形结石患者,可减少多通道手术过程中引起的出血、术后感染等并发症.

Application of guide wire and puncture needle in percutaneous nephrolithotomy

Objective To study the application of guide wire and puncture needle in percutaneous nephrolithotomy for improving the stone free rate.Methods Nineteen patients(11 males and 8 females) with staghorn stones admitted to our department from October 2008 to December 2009 were enrolled in this study.Their average age was 42.8 years.CT and pyelography showed staghorn stones in the left kidney of 11 patients and in the right kidney of 9 patients.General anesthesia was performed in all patients.Puncture was perform...