CAJ | 학술논문

目的探讨无管化的微通道经皮肾镜取石术(mPCNL)治疗嵌顿性输尿管上段结石的安全性、可行性及手术指征.方法回顾性分析2011年7月～ 2014年2月之间符合条件的152例输尿管上段结石患者,行一期无管化微通道经皮肾镜下钬激光碎石取石术.在B超引导下经皮肾穿刺并行通道扩张,建立F14～ F18的通道,碎石取石术后常规留置Double-J管及导尿管,记录每例所需要的手术时间、术中出血及输血情况,观察肾盂有无撕裂、有无临近器官损伤,计算结石清除率,记录术后导尿管留置时间及住院时间.结果 152例患者均成功实施一期碎石取石术,术后未留置肾造瘘管,F14通道21例,F16通道75例,F18号通道56例,平均手术时间(54±11) min,手中无活动性出血,无输血,无肾盂撕裂,无邻近脏器损伤.结石清除率97.3％(148/152),4例结石残留[均于术后3～5d复查KUB及B超提示残余结石直径分别为(4.0、3.6、3.5、3.2mm)].无明显尿外渗、大出血等严重并发症.术后平均留置导尿管3.8 ±0.7d.术后平均住院5.0±0.8d.结论针对性选择符合条件的嵌顿性输尿管结石患者,无管化的微通道经皮肾镜取石术效果满意,安全,术后恢复快,痛苦小,平均住院时间少.
목적 탐토무관화적미통도경피신경취석술(mPCNL)치료감돈성수뇨관상단결석적안전성、가행성급수술지정.방법 회고성분석2011년7월～ 2014년2월지간부합조건적152례수뇨관상단결석환자,행일기무관화미통도경피신경하화격광쇄석취석술.재B초인도하경피신천자병행통도확장,건립F14～ F18적통도,쇄석취석술후상규류치Double-J관급도뇨관,기록매례소수요적수술시간、술중출혈급수혈정황,관찰신우유무시렬、유무림근기관손상,계산결석청제솔,기록술후도뇨관류치시간급주원시간.결과 152례환자균성공실시일기쇄석취석술,술후미류치신조루관,F14통도21례,F16통도75례,F18호통도56례,평균수술시간(54±11) min,수중무활동성출혈,무수혈,무신우시렬,무린근장기손상.결석청제솔97.3％(148/152),4례결석잔류[균우술후3～5d복사KUB급B초제시잔여결석직경분별위(4.0、3.6、3.5、3.2mm)].무명현뇨외삼、대출혈등엄중병발증.술후평균류치도뇨관3.8 ±0.7d.술후평균주원5.0±0.8d.결론 침대성선택부합조건적감돈성수뇨관결석환자,무관화적미통도경피신경취석술효과만의,안전,술후회복쾌,통고소,평균주원시간소.
Objectives To study the security,feasibility and surgery indications of no pipe of microinvasive percutaneous nephrolithotomy with lithotomy(mPNCL) in treat incarcerated calculi of upper ureteral.Methods 152 patients of upper ureteral calculi were chosened to proceed no pipe of microinvasive percutaneous nephroscope holmium laser lithotripsy from July 2011 to February 2014.Under ultrasound guidance,152 patients were proceed with Percutaneous renal biopsy and expanded ureter,Established F 14-T18 channel.After opertation,indwelled Double J tube and catheter.Results 152 patients successfully proceeded no pipe of microinvasive percutaneous nephroscope holmium laser lithotripsy,all patients dosent indwell renal fistula after operation.21 cases of F14,75 cases of F16,56 cases of F56,The average operation time(54 ± 11) min.No bleeding,blood transfusion,renal pelvis laceration and adjacent viscera damage during operation.The calculi clearance was 97.3％ (148/152),and 4 patients with calculi residual(we finded calculi residual by KUB and B ultrasound after 3-5days,the diameter of thecalculi was (4.0、3.6、3.5、3.2mm)).Indwell catheter(3.8 ± 0.7) days and in hospital for (5.0 ± 0.7) days.They were no severe complications as obvious bleeding,urinary extravasation ect.Conclusions The effect of no pipe of microinvasive percutaneous nephrolithotomy with lithotomy (mPNCL)was satisfying,feasibility,fast postoperative recovery,less pain,less average length of hospital stay.