CAJ | 학술논문

目的：探讨双工作鞘在经皮肾取石术（PCNL）中应用的有效性及安全性。方法2008年1月～2013年11月，我科采用PCNL治疗肾、输尿管结石患者1260例，所有病例均建立F20通道，术中根据具体情况可在F20工作鞘的基础上再置入F16或F18的工作鞘作为内鞘，通过12F肾镜或9．8输尿管镜行碎石取石。结果所有病例均成功建立F20工作通道，其中1192例一期碎石取石，68例行二期经皮肾取石。一期手术时间12～120 min，平均53±8 min；二期手术时间15～42 min，平均18±5 min，术后结石总清除率为94．84％（1195/1260）。术后中～高热75例，因出血行肾血管介入治疗4例，未出现气胸、肠道损伤等严重并发症。结论在PCNL中应用双工作鞘有利于提高结石清除率、缩短手术时间、减少手术并发症，方法安全、有效，值得临床推广。
목적：탐토쌍공작초재경피신취석술（PCNL）중응용적유효성급안전성。방법2008년1월～2013년11월，아과채용PCNL치료신、수뇨관결석환자1260례，소유병례균건립F20통도，술중근거구체정황가재F20공작초적기출상재치입F16혹F18적공작초작위내초，통과12F신경혹9．8수뇨관경행쇄석취석。결과소유병례균성공건립F20공작통도，기중1192례일기쇄석취석，68례행이기경피신취석。일기수술시간12～120 min，평균53±8 min；이기수술시간15～42 min，평균18±5 min，술후결석총청제솔위94．84％（1195/1260）。술후중～고열75례，인출혈행신혈관개입치료4례，미출현기흉、장도손상등엄중병발증。결론재PCNL중응용쌍공작초유리우제고결석청제솔、축단수술시간、감소수술병발증，방법안전、유효，치득림상추엄。
Objective To evaluate the efficacy and safety of double working sheath in the appli-cations of percutaneous nephrolithotomy (PCNL). Methods From January 2008 to November 2013, 1260 patients with kidney or ureteral calculi were treated by PCNL..All cases were carried out F20 channel. During the operations, an F16 or F18 working sheath were put in the F20 working sheath as an inner sheath on the concrete circumstances as needed..The stones were fragmented and removed through an 12F rigid nephroscope or 9.8 F rigid ureteroscope..Results All cases were successfully to carry out F20 channel..No one died of operation..Among them,.1192 operations were successful in first stage. Sixty-eight cases performed second stage operations. The average operation time was 53 ±8 min (12 to 120 min) in the first stage. The average operation time was 18±5 min (15 to 42 min) in the second stage. The total stone-free rate was 94.84% (1195/1260). 75 cases had middle to high fever temperature post-operation..Four patients had to undergo renal vascular interventional therapy for severe bleeding after PCNL..No serious complications such as pneumothorax and intestinal injury. Conclusion Double working sheath in the applications of PCNL is helpful to improve stone-free rate , shorten the operation time and reduce the surgical complications. This method is safe , effective and worthy of clinical promotion.