PCNL进展分析课件.pptVIP

PCNL 处理儿科结石dealing with PAEDIATRIC STONE DISEASE, Ahmet Sahin Hacettepe University School of Medicine,TURKEYCukurova University School of Medicine, TURKEYOndokuz Mayis University School of Medicine, TURKEY 三个具有处理小儿结石中心进行PCNL的研究Three centers with experience in pediatric stone disease were included in this study. 在311个小儿行346例PCNL手术346 renal units were operated in 311 (M:211, F:100) pediatric patients. 用多参数的比较得出结论:PCNL对于小儿患较大的肾结石是标准选择的手术方法,合并症可接受The data regarding the patients , stones, surgery and postoperative course were collected from each center.the Conclusion: Percutaneous nephrolithotomy is a standard treatment option for most of the large stones in pediatrics with acceptable morbidity. PCNL 处理特殊和复杂及高危的病人 如何提高PCNL结石清除率 改善和提高体内碎石机的效率 PCNL面对的问题 开展PCNL如何降低风险 选择病人 前置肾造瘘管 病人手术体位 外周穿剌 B超导引穿剌 导丝的放置 通道扩张 谢谢! 合适的病例Suitability of case 适当的病人Suitability of patient 肥胖Obesity 结构混乱Structural deformity 出血倾向Bleeding diathesis 选择病人Selection of patients 选择病人Selection of patients Risk factors 末纠正内科合并症情况Uncorrected medical co-morbid conditions 糖尿病Diabetes, 高血压Hypertension, 肾功能不全Renal Insufficiency Effect of diabetes on blood loss P 0.05* Factors Affecting Blood Loss Percutaneous Nephrolithotomy : Prospective Study R.Kukreja, Mahesh Desai et al. Journal of Endourology 2004, 18(8):715-722 脓肾病Pyonephrosis 严重肾积水Gross Hydronephrosis 肾功能不全Renal insufficiency 前置肾造瘘管失血作用 Effect of Prestaged nephrostomy on blood loss P 0.0001** 病人手术体位Position of the patient 病人附卧位在胸部和骨盆处置垫子让腹部的内容垂下Prone position with bolsters under lower chest and pelvis to let the abdominal contents fall forward. 外周穿剌Peripheral Puncture 考虑到肾的解剖Respects the renal anatomy. 提供经肾实质到肾收集系统最短距离,因而减少对肾的损伤Offers the shortest trans-parenchymal access to the collecting system, thus minimizing renal trauma. 肾实质厚度对失血的影响 P 0.05* 避开较大的肾实质内血管,因而减少出血Avoids the larger intra parenchymal vessel, thus minimizing bleeding. 外周穿剌Peripheral Puncture 外周穿剌Peripheral Puncture 保持收集系统与肾实质紧密的联系,这样可减少外渗的发生 利用肾