CAJ | 학술논문

目的探讨6.4/8.0 F细硬输尿管肾镜在安全建立标准经皮肾通道中的临床意义.方法 198例肾结石患者全身麻醉成功后取俯卧位,人工肾积水条件下行患侧肾超声引导下目标肾盏穿刺,穿刺成功后采用Amplatz扩张器依次扩张至8F、10F、12F、14F、16F,更换Alken金属套叠扩张器,依次扩张至24 F标准通道并留置金属肾镜鞘.在扩张过程中用细硬输尿管肾镜检查12F、16 F经皮肾通道,确认通道扩张正常后继续扩张,发现问题及时处理或重新穿刺建立通道.结果 198例患者251侧肾一期顺利建立经皮肾通道,单通道231例次(92.0％,231/251),两通道15例次(6.0％,15/251),三通道5例次(2.0％,5/251).建立首个单通道时间15～ 40(27.5±12.4) min.除87例中重度肾积水患者外均顺利建立经皮肾通道,经皮肾通道扩张不完全20例次,均在导丝引导下6.4/8.0F细硬输尿管肾镜扩张肾皮质通道进入目标肾盏.通道丢失11例次,3例经输尿管导管向肾盂注入亚甲蓝,在输尿管肾镜下找到喷出蓝色液体的穿刺孔,插入斑马导丝,经皮肾通道也得以成功建立,8例经原通道重新超声定位穿刺目标肾盏,成功建立通道.肾皮质通道明显出血8例次,肾盂损伤4例次,均对碎石取石无显著影响.术中和术后输血20例次,无选择性肾动脉栓塞止血病例;术后发热32例次,无尿脓毒症病例.肾周血肿12例次,尿外渗32例次,气胸1例次,无肠道及肝脾损伤病例.结论 6.4/8.0 F细硬输尿管肾镜可提高标准经皮肾通道建立的安全性,减少并发症.
목적 탐토6.4/8.0 F세경수뇨관신경재안전건립표준경피신통도중적림상의의.방법 198례신결석환자전신마취성공후취부와위,인공신적수조건하행환측신초성인도하목표신잔천자,천자성공후채용Amplatz확장기의차확장지8F、10F、12F、14F、16F,경환Alken금속투첩확장기,의차확장지24 F표준통도병류치금속신경초.재확장과정중용세경수뇨관신경검사12F、16 F경피신통도,학인통도확장정상후계속확장,발현문제급시처리혹중신천자건립통도.결과 198례환자251측신일기순리건립경피신통도,단통도231례차(92.0％,231/251),량통도15례차(6.0％,15/251),삼통도5례차(2.0％,5/251).건립수개단통도시간15～ 40(27.5±12.4) min.제87례중중도신적수환자외균순리건립경피신통도,경피신통도확장불완전20례차,균재도사인도하6.4/8.0F세경수뇨관신경확장신피질통도진입목표신잔.통도주실11례차,3례경수뇨관도관향신우주입아갑람,재수뇨관신경하조도분출람색액체적천자공,삽입반마도사,경피신통도야득이성공건립,8례경원통도중신초성정위천자목표신잔,성공건립통도.신피질통도명현출혈8례차,신우손상4례차,균대쇄석취석무현저영향.술중화술후수혈20례차,무선택성신동맥전새지혈병례;술후발열32례차,무뇨농독증병례.신주혈종12례차,뇨외삼32례차,기흉1례차,무장도급간비손상병례.결론 6.4/8.0 F세경수뇨관신경가제고표준경피신통도건립적안전성,감소병발증.
Objective To explore the clinical significance of 6.4/8.0 F fine rigid ureteronephroscope in established standard percutaneous renal access.Methods One hundred and ninety-eight patients with kidney stones bed in prone position after general anesthesia,in the condition of artificial hydronephrosis underwent bilateral renal ultrasound guided target calyx puncture.After puncture success with Amplatz dilator expansion in turn to 8 F,10 F,12 F,14 F,16 F,then Alken metal telescope dilator was ultilized to dilation the passage to reach 24 F standard channel and lien metal nephroscope sheath.In the dilation course,the fine rigid ureteronephroscope was applied to inspect the 12 F and 16 F renal passage,continue to expand after confirmed normal channel expansion,which purpose was immediately found and solved the complications or re-establish the access.Results A total of 198 patients with 251 kidneys were successfully established percutaneous renal access at the first stage,231 cases (92.0％,231/251) with single tract,15 cases (6.0％,1 5/251) with double tracts and 5 cases(2.0％,5/251) with triple tracts.The time of establishing the first single tract was 15-40(27.5 ± 12.4) min.Except 87 patients with moderate to severe hydronephrosis were successfully established percutaneous renal access,20 cases with percutaneous renal access expansion incomplete,both under the 6.4/8.0 F fine rigid ureteronephroscope over the guided-wire into the target calyx.Channel lost in 11 cases,3 cases were injected methylene blue into renal pelvis through ureteral catheter,found out blue liquid puncture hole under the ureteronephroscope,insert the guided-wire to successfully established percutaneous renal access,8 cases with ultrasound guided target calyx puncture through original channel.Eight cases with renal cortical channel bleeding,4 cases with renal pelvic injury,none of them influenced the operation.During and after operation,20 cases needed blood transfusion,none of them underwent selective embolization of renal artery.Thirty-two cases with postoperative fever,no urosepsis occurred.Twelve cases with perinephric hematoma,32 cases with urinary extravasation and 1 case with pneumatothorax,no intestinal,liver and spleen damage occurred.Conclusion The 6.4/8.0 F fine rigid ureteronephroscope can help to improve safety and decrease complications of standard percutaneous renal access.