超声定位下行上尿路结石PCNL术中经皮肾穿刺定位及扩张体会

目的 总结行上尿路结石PCNL术中的超声定位、穿刺及扩张经验.方法 选取我科采用超声定位行上尿路结石PCNL术的532例患者的临床诊治资料,对其超声下定位、穿刺及扩张进行总结分析.结果 本组532例患者中529例成功碎石.38例肾积脓患者一期建立通道,二期碎石,6例无明显肾积水患者因穿刺后出血明显,二期碎石;单通道碎石461例,双通道碎石63例,三通道碎石5例.结论 超声下经皮肾穿刺定位及扩张 是成功碎石的保证,需熟悉肾脏血管的解剖,熟练掌握超声操作,注意穿刺及扩张技巧.

Experience on the positioning and expansion during percutaneous nephrolithotomy under ultrasound guidance for upper urinary tract calculi

Objective To assess the experience on the positioning and expansion during percutaneous nephrolithotomy （PCNL） under ultrasound guidance for upper urinary tract calculi.Methods The clinical data of 532 patients with upper urinary tract calculi treated with PCNL under ultrasound guidance was retrospectively analyzed.The experience on the positioning,puncturing and expansion was analyzed and summarized.Results Of the 532 patients,529 were treated successfully.Thirty-eight patients with pyonephrosis had percutaneous renal access successfully established in one-stage,and suffered second-stage lithotripsy.Six patients with hydronephrosis bled significantly and suffered two-stage lithotripsy.A single channel was used in 482 cases,double channels were used in 42 cases,and three channels were used in 5 cases.Conclusion Positioning and expansion during ultrasound-guided percutaneous nephrolithotomy is the assurance of successful lithotripsy.Surgeons need to be familiar with the anatomy of the renal vessels,master ultrasonic operation,and pay attention to the puncture and expansion skills.