经11肋上缘径路微创经皮肾镜处理肾上盏结石23例报告

目的:探讨经11肋上缘径路微创经皮肾镜术(MPCNL)处理肾上盏结石的安全性及临床疗效.方法:肾上盏多发性结石或鹿角型结石患者23例,男16例,女7例.均作全麻,气管插管选择双腔管,男性为F37,女性为F35.行患侧输尿管逆行插管,改体位为俯卧位,在B超定位下,于腋中线与腋后线之间紧贴11肋上缘进针,针尖方向指向上盏结石穿刺,穿刺时将患侧肺处于负压状态.沿导丝扩张形成F16的工作通道.置入输尿管镜或李逊镜,采用气压弹道碎石器在灌注泵配合下边冲洗边碎石.结果:23例均一期完成手术,无穿刺失败或中转开放手术.手术时间(65.6±14.8)min,出血量(150.2±42.2)ml,1例术中输红细胞2 U.结石清除率为86.9%(20/23).无术中大出血,无肠道、肝脾脏损伤等.1例出现液胸,术后并发症为肾周血肿1例,继发性出血1例.结论:经11肋上缘径路经皮肾镜处理肾上盏结石有足够的手术安全性,手术效果良好.

To evaluate the safety and efficacy of the supracostal approach of the 11th rib for percutaneous nephrolithotomy in treatment of upper calyx calculi (Report of 23 cases)

Objective:To evaluate the safety and clinical efficacy of the treatment of upper calyx calculi with minimally invasive percutaneous nephrolithotomy (MPCNL) through the upper edge of the 11th rib pathway.Methods:All of 23 cases (16 males and 7 females) with multiple upper calyx calculi or staghorn calculi underwent general anesthesia. Double-lumen endotracheal intubation were selected, F37 for male and F35 for female. Retrograde intubation of the trouble side ureter was done first. Change the posture to pron...