穿刺架辅助超声引导下建立经皮肾镜通道的临床观察

doi:10.3877/cma.j.issn.1674-3253.2019.01.006

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 24 -27. doi: 10.3877/cma.j.issn.1674-3253.2019.01.006

所属专题：文献；

临床研究

穿刺架辅助超声引导下建立经皮肾镜通道的临床观察

何祥彪¹^,^†(

), 刘杨洋¹, 黄贵闽¹, 杜丹¹, 徐进涛¹

^1. 614000　四川，乐山市人民医院泌尿外科

收稿日期:2018-03-11 出版日期:2019-02-01
通信作者: 何祥彪

Application of punture frame in establishing percutaneous nephroscope channel guided by ultrasound

Xiangbiao He¹^,^†(), Yangyang Liu¹, Guimin Huang¹, Dan Du¹, Jintao Xu¹

^1. Department of Urology, the People’s Hospital of Leshan, Sichuan 614000, China

Received:2018-03-11 Published:2019-02-01
Corresponding author: Xiangbiao He
About author:
Corresponding author: He Xiangbiao, Email: 546036415@qq.com

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目的

探讨穿刺架辅助在超声引导下建立经皮肾镜通道的有效性和安全性。

方法

我院自2016年10月至2017年12月成功实施经皮肾镜手术的肾结石患者106例，均在单纯超声下引导，并由穿刺架辅助穿刺建立通道，回顾性分析临床资料。

结果

平均穿刺时间（35±18） s，平均穿刺数（1.3±0.9）次，一次性穿刺成功73例，手术时间为（67±39） min，手术失血量约（48±22） ml。结石位于左侧50例，右侧56例，经肾上、中、下盏通道数分别为78例、20例、8例，穿刺点位于第12肋上、下分别为81例、25例，术中及术后输血4例，胸膜损伤2例，液气胸并行胸腔闭式引流术1例，单次手术清石率87.7%（93/106）。

结论

穿刺架辅助超声引导下建立经皮肾镜通道是一种有效、安全的方法。

关键词: 穿刺架, 超声, 经皮肾镜, 精准穿刺, 并发症

Objective

To investigate the clinical efficacy and safety of ultrasound-guided percutaneous nephroscopic surgery assisted by puncture frame.

Methods

Clinical data of 106 patients with kidney stones underwent ultrasound-guided percutaneous nephroscopic surgery from October, 2016 to December, 2017 in our hospital were analyzed retrospectively. The channel was established by puncture frame.

Results

The average puncture time was (35±18) s, the puncture was performed for (1.3±0.9) times on average. The puncture was successfully performed at one time in 73 cases. The operation time was (67±39) min, and the intraoperative blood loss was (48±22) ml. The stones were located on the left in 50 cases and on the right in 56 cases. The channels were established through the upper, middle or lower calyces of the kidney in 78, 20 and 8 cases, respectively. The puncture site was located on the upper or lower 12th rib in 81 and 25 cases. Intraoperative and postoperative blood transfusion was given in 4 cases, pleural injury occurred in 2 patients, hydropneumothorax occurred in one case and closed thoracic drainage was performed. The stone removal rate after single surgery was 87.7% (93/106).

Conclusions

Establish percutaneous nephroscopic channel under ultrasound-guided assisted by puncture frame is an efficacious and safe approach.

Key words: Puncture frame, Ultrasound, Percutaneous nephroscope, Precise puncture, Complication

图1 超声探头及穿刺架

[1]	Karamcheti A, O'Donnell WF. Percutaneous nephrolithotomy: an innovative extraction technique[J]. J Urol, 1977, 118(4): 671-672.
[2]	那彦群，叶章群，孙颖浩, 等. 中国泌尿外科疾病诊断治疗指南2014[M]. 北京: 人民卫生出版社, 2014: 169-170.
[3]	肖龙明，杨巧智，陈建发，等. 球囊与筋膜扩张法建立经皮肾镜标准通道的比较[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2016, 10(4): 255-258.
[4]	董传江，谢宗兰，张路生，等. 软性输尿管镜与经皮肾镜碎石术治疗直径≥2 cm肾结石疗效比较[J]. 微创泌尿外科杂志, 2016, 5(4): 196-198.
[5]	Xu H, Zisman AL, Coe FL, et al. Kidney stones: an update on current pharmacological management and future directions[J]. Expert Opin Pharmacother, 2013, 14 (4), 435-447.
[6]	Chau HL, Chan HC, Li TB, et al. An innovative free-hand puncture technique to reduce radiation in percutaneous nephrolithotomy using ultrasound with navigation system under magnetic field: a single-center experience in Hong Kong[J]. J Endourol. 2016, 30(2): 160-164.
[7]	Jian Li, JiSheng Lin, JunChuan Xu, et al. A novel approach for percutaneous vertebroplasty based on preoperative computed tomography-based three-dimensional model design[J]. World Neurosurg, 2017, 105: 20-26.
[8]	郑健忠，梁福律，范先明，等. 多通道经皮肾镜与单通道经皮肾镜联合输尿管软镜治疗复杂肾结石的效果比较[J]. 现代泌尿外科杂志, 2016, 21(8): 593-596.
[9]	Ng FC, Yam WL, Lim TYB, et al. Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations[J]. Investig Clin Urol , 2017, 58(5): 346-352.
[10]	赵华才，贾莉，陈远刚，等. 超声定位在经皮肾镜取石术中的应用[J]. 海南医学, 2016, 27(6): 987-990.
[11]	龙清志，李翔，贺大林，等. 经皮肾镜碎石术治疗1584例肾和输尿管结石患者的并发症及处理[J]. 现代泌尿外科杂志, 2016, 21(7): 516-519.
[12]	Chan CJ, Srougi V, Tanno FY, et al. Percutaneous puncture of renal calyxes guided by a novel device coupled with ultrasound[J]. Int Braz J Urol, 2015, 41(5): 953-958.
[13]	余伟民，曹君，阮远，等. 超声引导"经肾盏穹窿-盏颈轴线两步穿刺法"建立经皮肾通道[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2016, 10(3): 148-152.

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