中国伤残医学
中國傷殘醫學
중국상잔의학
CHINESE JOURNAL OF TRAUMA AND DISABILITY MEDICINE
2014年
3期
23-24,25
,共3页
彩超引导%微创经皮肾镜术%上尿路结石
綵超引導%微創經皮腎鏡術%上尿路結石
채초인도%미창경피신경술%상뇨로결석
Color doppler ultrasound guidance%Minimally invasive percutaneous nephrolithotomy%Upper urinary tract calculi
目的：探讨彩超引导技术在微创经皮肾镜术（ MPCNL）治疗上尿路结石中的引导及监护作用。方法：175例共183侧上尿路结石患者在彩超引导并监护下行微创经皮肾镜术治疗。结果：所有病侧在彩超引导下均成功建立皮肾通道，一期手术结石清除率为93．9％（172/183），平均手术时间121分钟（35～367分钟），平均出血量123ml（80～400ml）。11侧残余结石，其中8侧辅助1～2次体外冲击波碎石（ ESWL）治疗，3侧2次MPCNL治疗。2侧建立通道后发现出血量大，放置肾造瘘管后夹闭，7天后行MPCNL。患者均未发生气胸、腹腔脏器损伤等严重并发症。结论：彩超能实时引导穿刺针，提高皮肾通道建立的准确性，监测手术过程，减少手术的并发症，降低手术风险，在微创经皮肾镜术治疗上尿路结石中起到关键的作用，是首选的影像引导定位方法。
目的：探討綵超引導技術在微創經皮腎鏡術（ MPCNL）治療上尿路結石中的引導及鑑護作用。方法：175例共183側上尿路結石患者在綵超引導併鑑護下行微創經皮腎鏡術治療。結果：所有病側在綵超引導下均成功建立皮腎通道，一期手術結石清除率為93．9％（172/183），平均手術時間121分鐘（35～367分鐘），平均齣血量123ml（80～400ml）。11側殘餘結石，其中8側輔助1～2次體外遲擊波碎石（ ESWL）治療，3側2次MPCNL治療。2側建立通道後髮現齣血量大，放置腎造瘺管後夾閉，7天後行MPCNL。患者均未髮生氣胸、腹腔髒器損傷等嚴重併髮癥。結論：綵超能實時引導穿刺針，提高皮腎通道建立的準確性，鑑測手術過程，減少手術的併髮癥，降低手術風險，在微創經皮腎鏡術治療上尿路結石中起到關鍵的作用，是首選的影像引導定位方法。
목적：탐토채초인도기술재미창경피신경술（ MPCNL）치료상뇨로결석중적인도급감호작용。방법：175례공183측상뇨로결석환자재채초인도병감호하행미창경피신경술치료。결과：소유병측재채초인도하균성공건립피신통도，일기수술결석청제솔위93．9％（172/183），평균수술시간121분종（35～367분종），평균출혈량123ml（80～400ml）。11측잔여결석，기중8측보조1～2차체외충격파쇄석（ ESWL）치료，3측2차MPCNL치료。2측건립통도후발현출혈량대，방치신조루관후협폐，7천후행MPCNL。환자균미발생기흉、복강장기손상등엄중병발증。결론：채초능실시인도천자침，제고피신통도건립적준학성，감측수술과정，감소수술적병발증，강저수술풍험，재미창경피신경술치료상뇨로결석중기도관건적작용，시수선적영상인도정위방법。
Purpose:To investigate the guiding and supervising effect of color doppler ultrasound in minimally invasive percutaneous nephrolithotomy in the treatment of upper urinary tract calculi .Methods:175 cases with 183 sides of upper urinary tract calculi undergone minimally invasive percutaneous nephrolithotomy .All treatments were performed under the guidance and super vion of color doppler ultra -sound.Results:All the disease side with the guidance of ultrasound percutaneous renal access was successfully established .The calculi clearance rate of one stage operation was 93.9% (172/183), the average operation time was 121min (35-367min), and the average blood loss was 123ml (80-400ml).There were 11 sides with residual calculi , including 8 sides which had treated auxiliarily by ESWL for 1-2 times and 3 sides which had treated by second MPCNL .Hemorrhage was found in 2 sides after building channel which had treated by MPCNL after placing and clipping renal fistula in 7 days.There were no severe complications , such as pneumothorax and injury of ab-dominal organs in the patients .Conclusion:CDFI can provide real-time guidance for puncture needle , increase the accuracy of the per-cutaneous renal access establishment , supervise the process of operation , reduce operation complication , and reduce the operation risk .It played a key role in minimally invasive percutaneous nephrolithotomy treatment urinary tract calculis and should be regarded as the imaging-guided localizing method of first choice .
