国际泌尿系统杂志
國際泌尿繫統雜誌
국제비뇨계통잡지
INTERNATIONAL JOURNAL OF UROLOGY AND NEPHROLOGY
2014年
3期
322-324
,共3页
尿路结石%碎石术,激光%激光,固体
尿路結石%碎石術,激光%激光,固體
뇨로결석%쇄석술,격광%격광,고체
Urinary Calculi%Lithotripsy,Lasers%Lasers,Solid-State
目的 探讨无穿刺架超声引导经皮肾镜钬激光或EMS4代取石术治疗上尿路结石的可行性.方法 选取2011年7月～2013年8月采用无穿刺架超声引导经皮肾镜钬激光或EMS4代取石术治疗34例上尿路结石.其中肾结石25例,输尿管上段结石5例,肾结石并输尿管上段结石4例.输尿管上段结石直径0.7 ～2.4cm,平均1.6cm;肾结石直径1.5～4.3cm,平均2.3cm.在肩胛下角线、腋后线第11肋间或第12肋下区域,用无穿刺架的超声探头广泛检查肾脏各切面,确定皮穿刺点、目标肾盏以及穿刺角度和深度.依据皮肤穿刺点,选择在探头上下方沿探头面纵轴线或探头内外侧中点处穿刺,在超声引导下将18G针穿刺目标肾盏,建立F16、F18或F24通道.F8/9.8输尿管镜下钬激光或EMS4代取石.结果 所有患者成功建立F16 ～24通道并进行钬激光或EMS4代取石,为单通道或双通道.手术时间27 ～ 185min,平均88min,出血20 ～ 600mL,平均58mL.30例Ⅰ期碎石成功,4例因术中出血和肾周积液,于术后4～7d行Ⅱ期取石.术后4周复查KUB及超声,结石排净率88.2％(30/34).未出现严重出血、液气胸、腹腔脏器损伤等并发症.结论 无穿刺架超声引导经皮肾镜钬激光或EMS4代取石术治疗上尿路结石定位准确,安全有效.
目的 探討無穿刺架超聲引導經皮腎鏡鈥激光或EMS4代取石術治療上尿路結石的可行性.方法 選取2011年7月～2013年8月採用無穿刺架超聲引導經皮腎鏡鈥激光或EMS4代取石術治療34例上尿路結石.其中腎結石25例,輸尿管上段結石5例,腎結石併輸尿管上段結石4例.輸尿管上段結石直徑0.7 ～2.4cm,平均1.6cm;腎結石直徑1.5～4.3cm,平均2.3cm.在肩胛下角線、腋後線第11肋間或第12肋下區域,用無穿刺架的超聲探頭廣汎檢查腎髒各切麵,確定皮穿刺點、目標腎盞以及穿刺角度和深度.依據皮膚穿刺點,選擇在探頭上下方沿探頭麵縱軸線或探頭內外側中點處穿刺,在超聲引導下將18G針穿刺目標腎盞,建立F16、F18或F24通道.F8/9.8輸尿管鏡下鈥激光或EMS4代取石.結果 所有患者成功建立F16 ～24通道併進行鈥激光或EMS4代取石,為單通道或雙通道.手術時間27 ～ 185min,平均88min,齣血20 ～ 600mL,平均58mL.30例Ⅰ期碎石成功,4例因術中齣血和腎週積液,于術後4～7d行Ⅱ期取石.術後4週複查KUB及超聲,結石排淨率88.2％(30/34).未齣現嚴重齣血、液氣胸、腹腔髒器損傷等併髮癥.結論 無穿刺架超聲引導經皮腎鏡鈥激光或EMS4代取石術治療上尿路結石定位準確,安全有效.
목적 탐토무천자가초성인도경피신경화격광혹EMS4대취석술치료상뇨로결석적가행성.방법 선취2011년7월～2013년8월채용무천자가초성인도경피신경화격광혹EMS4대취석술치료34례상뇨로결석.기중신결석25례,수뇨관상단결석5례,신결석병수뇨관상단결석4례.수뇨관상단결석직경0.7 ～2.4cm,평균1.6cm;신결석직경1.5～4.3cm,평균2.3cm.재견갑하각선、액후선제11륵간혹제12륵하구역,용무천자가적초성탐두엄범검사신장각절면,학정피천자점、목표신잔이급천자각도화심도.의거피부천자점,선택재탐두상하방연탐두면종축선혹탐두내외측중점처천자,재초성인도하장18G침천자목표신잔,건립F16、F18혹F24통도.F8/9.8수뇨관경하화격광혹EMS4대취석.결과 소유환자성공건립F16 ～24통도병진행화격광혹EMS4대취석,위단통도혹쌍통도.수술시간27 ～ 185min,평균88min,출혈20 ～ 600mL,평균58mL.30례Ⅰ기쇄석성공,4례인술중출혈화신주적액,우술후4～7d행Ⅱ기취석.술후4주복사KUB급초성,결석배정솔88.2％(30/34).미출현엄중출혈、액기흉、복강장기손상등병발증.결론 무천자가초성인도경피신경화격광혹EMS4대취석술치료상뇨로결석정위준학,안전유효.
Objectives To discuss the feasibility of ultrasound-guided minimally invasive percutaneous nephrohthotomy(PCNL) without using a puncture needle holder for renal and upper ureteral stones.Methods From July 2011 to August 2013,weperformed PCNL under the guidance by ultrasonography without a puncture needle holder on 34 patients with upper urinary calculi.Among the cases,25 patients had renal stones,5 patients had upper ureteral stones,and 4 had renal stones complicated with ipsilateralupper ureteral stones.The size of the upper ureteral stones ranged from 0.7 to 2.4cm with a mean of 1.7 cm in diameter,and that of the renal stones ranged from 1.5 to 4.3 cm with a mean of 2.3 cm.To determine the target renal calices,and site,angle and depth of puncture,between the infrascapular and posterior axillary lines,at the 11th intercostal region or below the 12th rib,we crisscrossedlydetected the kidney with an ultrasound probe.With the probe in left hand and a puncture needle in the right hand,under the guidanceby ultrasonography,we inserted an 18-G puncture needle into the target renalcalices,so that to build a F16--F18 orF24 channel.Afterwards,holmium laser lithotripsy was carried out under a F9.8ureteroscope.Results Single F16 ～ 18 or F24 Channel was established in all the patients,and holmium laser lithotripsy was completed within a mean of 88 minutes (ranged from 27 to 185 minutes).The mean intraoperative blood loss was 58 ml (ranged from 20 to 600 nil).Thelithotripsy was succeeded in 30 of the patients in one session,and the other four received a second lithotripsy in 4 to 7 days after the firstsession because of intraoperative hemorrhage or perirenal effusion.Postoperative examination by KUB and ultrasonography showed thatthe stone clearance rate was 882％ (30/34).No patients had massive hemorrmge,hydropneumothorax or injuries to the abdominalorgans.Conclusions It is safe,feasible and effective to perfrom PCNL under ultrasound guidance without using puncture needleholder.The approach is accurate in positioning upper urinary stones.
