国际外科学杂志
國際外科學雜誌
국제외과학잡지
INTERNATIONAL JOURNAL OF SURGERY
2012年
5期
320-323
,共4页
李九智%王雪怡%李建兴%文彬%罗勇%安尼瓦尔·玉素甫%王岩岗%阿不力孜·司马义
李九智%王雪怡%李建興%文彬%囉勇%安尼瓦爾·玉素甫%王巖崗%阿不力孜·司馬義
리구지%왕설이%리건흥%문빈%라용%안니와이·옥소보%왕암강%아불력자·사마의
小儿结石%经皮肾镜碎石术%彩超
小兒結石%經皮腎鏡碎石術%綵超
소인결석%경피신경쇄석술%채초
Pediatric urinary stones%Percutaneous nephrolithotomy%Doppler ultrasonography
目的 评价彩超定位引导穿刺在小儿经皮肾镜碎石术中的安全性和优势.方法 回顾性分析2006年5月-2011年8月应用彩超定位引导穿刺的微创经皮肾镜取石术治疗5岁以下患者上尿路结石患者165例.全部采用超声引导穿刺的微通道(12~16 F)经皮肾镜碎石术,气压弹道和/或超声碎石系统击碎并清除结石.结果 本组结石平均直径为(15.82±6.31) mm.所有病例均在彩超定位引导下一期成功建立通道并处理结石,通道建立时间为(11.7±5.3) min,手术时间为(42.6±20.1) min.净石率为95.2%(157/165).术后69.7% (115/165)的患者出现血红蛋白和红细胞压积下降,血红蛋白平均下降2.67 g/L,红细胞压积平均下降2.21%.术后23.03% (38/165)的患者超过48 h的持续性或反复发热(≥38.5℃).无失肾、死亡病例,无术后输血病例,无感染休克病例,无邻近脏器损伤病例.结论 彩超定位引导穿刺在小儿微创经皮肾镜皮肾通道建立中能够充分清晰地显示入路上各层组织,肾周脏器毗邻关系,明确、客观、实时的显示肾血管并实时引导避开血管引导穿刺,有效减少术中出血、损伤等并发症,是安全、可靠的定位引导工具.
目的 評價綵超定位引導穿刺在小兒經皮腎鏡碎石術中的安全性和優勢.方法 迴顧性分析2006年5月-2011年8月應用綵超定位引導穿刺的微創經皮腎鏡取石術治療5歲以下患者上尿路結石患者165例.全部採用超聲引導穿刺的微通道(12~16 F)經皮腎鏡碎石術,氣壓彈道和/或超聲碎石繫統擊碎併清除結石.結果 本組結石平均直徑為(15.82±6.31) mm.所有病例均在綵超定位引導下一期成功建立通道併處理結石,通道建立時間為(11.7±5.3) min,手術時間為(42.6±20.1) min.淨石率為95.2%(157/165).術後69.7% (115/165)的患者齣現血紅蛋白和紅細胞壓積下降,血紅蛋白平均下降2.67 g/L,紅細胞壓積平均下降2.21%.術後23.03% (38/165)的患者超過48 h的持續性或反複髮熱(≥38.5℃).無失腎、死亡病例,無術後輸血病例,無感染休剋病例,無鄰近髒器損傷病例.結論 綵超定位引導穿刺在小兒微創經皮腎鏡皮腎通道建立中能夠充分清晰地顯示入路上各層組織,腎週髒器毗鄰關繫,明確、客觀、實時的顯示腎血管併實時引導避開血管引導穿刺,有效減少術中齣血、損傷等併髮癥,是安全、可靠的定位引導工具.
목적 평개채초정위인도천자재소인경피신경쇄석술중적안전성화우세.방법 회고성분석2006년5월-2011년8월응용채초정위인도천자적미창경피신경취석술치료5세이하환자상뇨로결석환자165례.전부채용초성인도천자적미통도(12~16 F)경피신경쇄석술,기압탄도화/혹초성쇄석계통격쇄병청제결석.결과 본조결석평균직경위(15.82±6.31) mm.소유병례균재채초정위인도하일기성공건립통도병처리결석,통도건립시간위(11.7±5.3) min,수술시간위(42.6±20.1) min.정석솔위95.2%(157/165).술후69.7% (115/165)적환자출현혈홍단백화홍세포압적하강,혈홍단백평균하강2.67 g/L,홍세포압적평균하강2.21%.술후23.03% (38/165)적환자초과48 h적지속성혹반복발열(≥38.5℃).무실신、사망병례,무술후수혈병례,무감염휴극병례,무린근장기손상병례.결론 채초정위인도천자재소인미창경피신경피신통도건립중능구충분청석지현시입로상각층조직,신주장기비린관계,명학、객관、실시적현시신혈관병실시인도피개혈관인도천자,유효감소술중출혈、손상등병발증,시안전、가고적정위인도공구.
Objective To evaluate the advantages of color doppler ultrasonography guidence in mini-invasive percutaneous nephrostolithotripsy(mPCNL) for pediatric patients.Methods From May 2006 to August 2011,a total of 165 pediatric cases with upper urinary stone,who were treated by mPCNL with F12-F16 access route,were respectively reviewed.All procedures were under the guidance of color doppler ultrasonography,and the pneumatic lithotripsy and/or EMS ultrasound lithotripsy were used to disintegrate the stones.Results In one-stage mPCNL,The average length of the stones was ( 15.82 ±6.31 ) mm,all 165 cases were treated,during which percutaneous renal access was successfully established under color doppler ultrasound guidance and stones were fragmentated.The mean duration of renal access establishment was (11.7 ± 5.3 ) min.The one-stage stone free rate was 95.2%(157/165) with the operation time of (42.6 ± 20.1 ) min.The postoperative hemoglobin aud hematocrit decline were observed in 69.7 % ( 115/165 ) of the cases with the value of 2.67 g/L and 2.21% respectively when compared with their preoperative counterpart. Infection rate related to operation was 23.03% ( 38/165 ),which was demostrated by durative or iterative fever more than 48 hours.No perioperative bleeding was recorded,and no transfusion was required.No ease experienced perirenal organ injury.Conclusions Using color doppler ultrasound guidance during m-PCNL resulted in safe and effective therapeutic method for upper urinary stone,and can be considered as measures of choice for guidence of mPCNL in pediatric patients.