CAJ | 학술논문

目的评价侧卧位B超引导下经皮肾镜取石术(PCNL)治疗复杂性肾结石的疗效及安全性. 方法复杂性肾结石患者650例.男512例,女138例.平均年龄38(11～78)岁.结石位于左肾366例,右肾284例.单发121例,多发42例,部分鹿角形结石392例,全鹿角形结石95例.肾结石平均长径31(20～58)mm.均行侧卧位B超引导下PCNL治疗. 结果 650例手术顺利.B超引导下穿刺均成功,Ⅰ期微通道气压弹道碎石术493例,标准通道气压弹道和(或)超声联合碎石清石术157例.Ⅰ期结石取净563例(86.6 0%),Ⅱ期取净65例(10.0%),Ⅲ期取净6例,有残余结石者16例联合使用ESWL治疗.Ⅰ期PCNL平均手术时间72(35～145)min.未发生气胸、结肠损伤、肾盂穿孔、水中毒、肾周感染等合并症.平均住院时间18(9～32)d. 结论侧卧位B超引导下PCNL治疗复杂性肾结石安全有效,患者耐受性好,便于麻醉管理,医护人员和患者避免x线辐射损伤,是一种值得推荐的微创治疗方法.
목적 평개측와위B초인도하경피신경취석술(PCNL)치료복잡성신결석적료효급안전성. 방법 복잡성신결석환자650례.남512례,녀138례.평균년령38(11～78)세.결석위우좌신366례,우신284례.단발121례,다발42례,부분록각형결석392례,전록각형결석95례.신결석평균장경31(20～58)mm.균행측와위B초인도하PCNL치료. 결과 650례수술순리.B초인도하천자균성공,Ⅰ기미통도기압탄도쇄석술493례,표준통도기압탄도화(혹)초성연합쇄석청석술157례.Ⅰ기결석취정563례(86.6 0%),Ⅱ기취정65례(10.0%),Ⅲ기취정6례,유잔여결석자16례연합사용ESWL치료.Ⅰ기PCNL평균수술시간72(35～145)min.미발생기흉、결장손상、신우천공、수중독、신주감염등합병증.평균주원시간18(9～32)d. 결론 측와위B초인도하PCNL치료복잡성신결석안전유효,환자내수성호,편우마취관리,의호인원화환자피면x선복사손상,시일충치득추천적미창치료방법.
Objective To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) with B ultrasound-guided renal access in the lateral decubitus flank position for complex renal calculi. Methods From June 2004 to August 2009, 650 patients with renal stones≥20 mm underwent PCNL with B ultrasound-guided renal access in the lateral decubitus flank position. 512 men and 138 women,with a mean age of 38 years(range 11 - 78 years)and a mean stone size of 31 mm(range 20 - 58 mm). Results Successful access was achieved in 650 patients (100%). Minimally PCNL and PCNL were performed in 493 and 157 patients. Complete stone clearance rate was 86. 6% (563/ 650). The mean operative time was 72 min(range 35 - 145 min), and the mean hospital stay was 18d (range 9 - 32 d). There were no visceral injuries. Conclusions PCNL with B ultrasound-guided renal access in the lateral decubitus flank position is safe and convenient, and prevents harmful effects of radiation for the surgeon, the surgical team, and the patient.