单用B超引导建立经皮肾穿刺通道行经皮肾镜取石术(附102例报告)

目的：评估B超引导下建立经皮肾穿刺通道行经皮肾镜取石术（PCNL）的方法及效果。方法：收治102例肾结石患者。前50例先行B超定位下经皮肾微穿制备瘘，置入F10硅胶引流管，1周后经造瘘管放入导丝。B超引导下用Cook扩张器扩张穿刺通道，再行PCNL；对后52例患者行一期B超引导下建立经皮肾穿刺通道PCNL。结果；102例患者1次取净结石69例，1周后经瘘管再行PCNL取净结石23例，再次手术结石总取净率为91.0%。手术时间平均2.5h。术中6例患者输血，输血量平均230ml。早期2例患者出现腹腔积液，1例术后2周出现肾动静脉瘘，1例肾盂输尿管连接处狭窄。经及时治疗后痊愈。结论：单用B超引导建立经皮肾穿刺通道行PCNL技术上可行，能在基层医院推广。

Developing renal tract for percutaneous nephrostolithotomy solely under the guide of B-Ultrasound (Report of 102 cases)

Purpose:To evaluate the feasibility and availability of sonographically percutaneous nephrolithotomy (PCNL) in treatment of renal calculi.Methods:Here reported 102 cases of renal calculi in this group. The first 50 cases underwent two stage procedure for PCNL. That is a percutaneous micronephrostomy guided by ultrasound B established and one week later the PCNL was carried out in which a guiding wire was introduced through the nephrostomic tubing followed by a series of dilation solely under the guidance of B sonography.While a nephrostomy sheath was placed properly, a 26F nephroscope or a ureteroscope was used through to manage the calculi. Results:69 cases presented stone free on the first PCNL and 33 others still had residual stone and underwent the second management. So the total stone clearence amounted to 91.0 % by the first and second operation.The average operation time was 2.5 h;6 cases had transfusion during the PCNL and averaged 230 ml; The complications were discovered of extravasation of fluid in abdominal cavity on 2 cases, renal artery vein fistula on 1 case and UPJ stricture on 1 cases.All these complications were treated properly.Conclusions:Solely sonographic guidance is available to the PCNL and it is, indeed, applicable to all urologic centers.