超声与X线联合定位MPCNL处理上尿路阴性结石

目的 :探讨上尿路阴性结石行MPCNL（微创经皮肾镜术）治疗的手术技巧。方法: 根据术前B超检查及CT扫描，分析决定经皮肾穿刺的角度和深度。术中先用B超定位，穿刺出尿液后从穿刺针注入造影剂，再在X光透视下完整显示集合系统，然后选择最理想的目标肾盏进行二次穿刺扩张建立理想的经皮肾通道。若结石位于输尿管上段或肾盂，则选择后组中盏；当结石位于肾盏则选择相应的肾盏；若结石位于输尿管远端10cm以上则选择上盏。成功建立理想的经皮肾通道是手术成败的关键。术中根据具体情况采用肾镜或输尿管镜进行取石。 结果：85例单侧上尿路结石患者均经MPCNL术成功取石，术后复查无结石残留，无周围脏器包括膈肌、脾脏、结肠等重要脏器的损伤，出血较少，无一例因穿刺失败而中转开放手术。 结论：利用B超和X线双定位并根据具体情况采用肾镜或输尿管镜进行取石有利于提高阴性结石进行MPCNL术的成功率。

Combimed Ultrasound with X ray for localization MPCNL in the treatment of upper urinary radioparent calculus

Objective To investigate the efficacies of upper urinary calculus on ultrasound and X ray localization minimally invasive percutaneous nephrolithotripsy.Methods According to preoperative B-mode ultrasound examination and CT fillm to understand position of calculus,bilateral kidney form,degree of hydrops,size and location of calculus,the angle and depth of percutaneous renal puncture were decided.B-mode ultrasound localization was used during operation.After urine was aspirated,the contrast medium was injected from puncture needle.The collecting system was displayed completely under fluoroscopy.And then most ideal target renal calices was selected to perform second puncture and dilatation for establishina ideal percutaneous renal pathway.According to the specific condition,the renoscope or ureteroscope was used to remove calculus during operation.Results Eighty five cases with unilateral upper utinary calculus underwent MOCNL successfully.No residual calculus was found during postoperative re-examination.No surrounding organs,including diaphragm,soleen,colon and so on,were injured.No one case transferred to open operation because of puncture failed.Conclusion Utilizing B-mode ultrasound X ray double localization and according to specific calculus,which it contribute to enhance the successful rate of MPCNL for upper urinary radioparent calculus.