CAJ | 학술논문

目的探讨微造瘘经皮肾镜吸引清石系统结合超声在治疗鹿角形肾结石中的价值.方法回顾性分析2008年8月至2011年4月302例鹿角形肾结石患者的临床资料,男158例,女144例.年龄3.5 ～65.0岁,平均41.0岁.合并集合系统积水216例,合并集合系统积脓37例;34例有开放取石手术史.患者均应用微造瘘经皮肾镜吸引清石系统结合超声治疗.硬膜外或全麻下,俯卧位,肾脏不固定,术中应用B超引导穿刺建立14 ～ 16 F通道,利用硬质工作鞘活动灵活的特点,在连续大流量灌注持续低负压吸引下,采用100 W钬激光碎石,术中结合B超引导同步吸引取石.结果 302例均成功建立通道,共建立通道329个.291例一期手术,11例合并集合系统积脓行造瘘后二期取石.手术采用单通道280例(92.7％)、双通道17例(5.6％)、三通道5例(1.7％);低位入路通道322个(97.9％),高位入路通道7个(2.1％).平均每个通道建立时间3.2 min,平均取石时间55.4 min.一期结石清除率为89.7％ (271/302),单通道一期结石清除率为90.0％(252/280),ESWL或二期经皮肾镜手术后结石清除率为98.0％(296/302).输血11例(3.6％),术后介入治疗4例(1.3％),术后发热25例(8.3％),无周围脏器损伤,无死亡病例.结论微造瘘经皮肾镜吸引清石系统结合超声治疗鹿角形肾结石,工作鞘活动度大,取石方便灵活.术中应用超声引导快速、安全、准确,通道设计更合理,能够提高单通道一期清石率,手术更安全.
목적 탐토미조루경피신경흡인청석계통결합초성재치료록각형신결석중적개치.방법 회고성분석2008년8월지2011년4월302례록각형신결석환자적림상자료,남158례,녀144례.년령3.5 ～65.0세,평균41.0세.합병집합계통적수216례,합병집합계통적농37례;34례유개방취석수술사.환자균응용미조루경피신경흡인청석계통결합초성치료.경막외혹전마하,부와위,신장불고정,술중응용B초인도천자건립14 ～ 16 F통도,이용경질공작초활동령활적특점,재련속대류량관주지속저부압흡인하,채용100 W화격광쇄석,술중결합B초인도동보흡인취석.결과 302례균성공건립통도,공건립통도329개.291례일기수술,11례합병집합계통적농행조루후이기취석.수술채용단통도280례(92.7％)、쌍통도17례(5.6％)、삼통도5례(1.7％);저위입로통도322개(97.9％),고위입로통도7개(2.1％).평균매개통도건립시간3.2 min,평균취석시간55.4 min.일기결석청제솔위89.7％ (271/302),단통도일기결석청제솔위90.0％(252/280),ESWL혹이기경피신경수술후결석청제솔위98.0％(296/302).수혈11례(3.6％),술후개입치료4례(1.3％),술후발열25례(8.3％),무주위장기손상,무사망병례.결론 미조루경피신경흡인청석계통결합초성치료록각형신결석,공작초활동도대,취석방편령활.술중응용초성인도쾌속、안전、준학,통도설계경합리,능구제고단통도일기청석솔,수술경안전.
Objective To determine the efficacy and practicability of a stone-breaking and suction system combined with ultrasonography in treating staghorn renal calculi by using minimally invasive percutaneous nephrolithotomy (mPCNL).Methods From August 2008 to April 2011,we retrospectively review our outcome when using mPCNL to treat staghorn renal calculi in 302 patients with the aid of a stone-breaking and suction system combined with ultrasonography.There were 158 males and 144 females.Their age ranged from 3.5 to 65.0 years with a mean age of 41.0.There were 216 cases complicated by hydronephrosis,37 cases complicated by pyonephrosis and 34 cases having a history of open surgery to remove the stones.During the surgery,the patient was placed in a flat prone position without boosting the abdomen to prevent the fixation of the kidneys.The mPCNL was performed after establishing a percutaneous tract under the guidance of ultrasonography.With the aid of the stone-breaking and suction system including a rigid sheath with high flexibility in movement,the lithotripsy was performed using a 100 Watt holmium laser under continuous large volume saline irrigation.Ultrasonography was also used intraoperatively to guide lithotripsy and stone clearance.Results Percutaneous tracts were established successfully in all 302 cases.There were 291 cases that had lithotripsy on the first surgery and 11 cases that underwent a second-stage lithotripsy due to complicated pyonephrosis.There were 280 cases in which a single percutaneous tract was used,17cases in which double percutaneous tracts were used,and 5 cases in which 3 percutaneous tracts were used.Three hundred and twenty two of 329 percutaneous tracts were established using a 12th rib infracostal approach,the remaining 7 percutaneous tracts were established using a 1 1th or 12th rib supracostal approach.The average time in establishing a percutaneous tract was 3.2 min.The average stone clearance time was 55.4 min.Stone clearance rate by one surgery using one percutaneous tract was 252/280.Stone clearance rate after supplemental therapies such as ESWL or percutaneous nephrolithotomy (Ⅱ) was 296/302.The percentage of blood transfusion was 11/302.The percentage of interventional embolization was 4/302.The percentage of postoperative fever was 25/302.There was neither injury to surrounding organs nor death during or after the surgery.Conclusions There are several advantages of mPCNL with the aid of the stonebreaking and suction system combined with ultrasonography.First,It is simple,convenient,and safe procedure which had a high successful rate.Second,it can help in designing a more reasonable percutaneous tract.Third,the stone clearance rate was increased by using B ultrasound guidanc e intraoperatively and the rigid sheath with high flexibility in movement.