CAJ | 학술논문

目的探讨行无管化经皮肾镜取石术的最初经验、疗效、安全性及其优点.方法2009年4月至2012年12月对肾和输尿管上段结石患者行经皮肾镜手术的被列入研究组计划,当手术结束时确认无结石残留,无严重的出血,无明显集合系统的损伤即可不放置肾造瘘管和(或)输尿管支架管.鹿角形结石、结石的大小、仰卧位穿刺、俯卧位穿刺、肾脏解剖结构异常、孤立肾、手术时间为非影响因素.结果共施行无管化的经皮肾镜取石术48例,其中包括5例完全无管化的经皮肾镜取石术.患者术后恢复快,费用相对较低,48例患者均在短期内出院.其中1例双侧同时部分无管的患者出现术后高热,更换头孢三代抗生素后体温恢复正常.1例完全无管的出现术后剧烈的疼痛,给予对症处理后痊愈出院.结论无管化经皮肾镜取石术治疗肾和输尿管上段结石是一种经济、安全、有效的方法,是否行无管化决定于手术结束时术者的判断.
목적탐토행무관화경피신경취석술적최초경험、료효、안전성급기우점.방법2009년4월지2012년12월대신화수뇨관상단결석환자행경피신경수술적피렬입연구조계화,당수술결속시학인무결석잔류,무엄중적출혈,무명현집합계통적손상즉가불방치신조루관화(혹)수뇨관지가관.록각형결석、결석적대소、앙와위천자、부와위천자、신장해부결구이상、고립신、수술시간위비영향인소.결과공시행무관화적경피신경취석술48례,기중포괄5례완전무관화적경피신경취석술.환자술후회복쾌,비용상대교저,48례환자균재단기내출원.기중1례쌍측동시부분무관적환자출현술후고열,경환두포삼대항생소후체온회복정상.1례완전무관적출현술후극렬적동통,급여대증처리후전유출원.결론무관화경피신경취석술치료신화수뇨관상단결석시일충경제、안전、유효적방법,시부행무관화결정우수술결속시술자적판단.
@@@@Objectives To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection and evaluate the safety and feasibility of tubeless percutaneous nephrolithotomy. Methods All consecutive PCNL performed during 2009-2012 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless. PCNL over time. Results Of 600 PCNL performed during the study period 48 (71%) were tubeless. Including 5 cases of the procedure was totally tubeless percutaneous nephrolithotomy. The postoperative recovery time and relatively cost was low, 48 patients were discharged in the short term. 1 case of bilateral and tubeless percutaneous nephrolithotomy appears postoperative high fever. The temperature returned to normal after replace cephalosporins antibiotics of three generations. One patient with totally tubeless percutaneous nephrolithotomy had severe postoperative pain and discharge after give received alimta. conclusion Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without preoperative contraindications. They are easily accommodated by experienced endourologists and provide real advantages.