B超引导下经皮肾镜取石术成功建立皮肾通道的体会.docVIP

B超引导下经皮肾镜取石术成功建立皮肾通道的体会 　　摘要：目的：探讨B超引导下成功建立皮肾通道的技巧，以期提高经皮肾镜碎石取石术的成功率，减少手术并发症。方法：在 B超引导下选择最近皮肾距离、穿刺方向指向肾盂等原则行PCNL治疗肾输尿管结石276例，取得较好效果。结果：本组276例，均成功建立皮肾通道，手术时间45-146分钟，平均85分钟，单通道取石245例（88.6%），多通道取石31例（11.4%），结石一期取净217例（78.6%），二期取净36例（13.1%），结合ESWL排净23例（8.3%）。结论：具备扎实的超声影像学知识至关重要;选择最近皮肾距离、穿刺方向朝向肾盂是成功建立皮肾工作通道的重要因素。 　　关键词：B超;肾结石;经皮肾镜碎石取石术 　　Search for the establishment of percutaneous nephrolithotomy standard channel under the guidance of ultrasonogrphy 　　LIN Hai-li， ZHENG Zhou-da， LIU Hong-jie ，SHEN Zai-xiong. 　　（Department of Urology， The Affiliated Zhangzhou City Hospital of Fujian Medical University， Zhangzhou 363000， Fujian，China） 　　[Abstract] Objective To evaluate the establishment of percutaneous nephrolithotomy standard channel under the guidance of ultrasonogrphy， in order to reduce the operation complications， improve the stone clearance rate. Methods according to the principle of the shortest distance of skin to renal and the direction of renipuncture tend to renal pelvis，standing channel under the guidance of ultrasonogrphy of PCNL treat renal and ureteral calculi in 276 cases， to achieve better results. Results 276 cases of this group， all the patients were successfully established percutaneous renal access， operation time of 45 - 146 minutes， average 85 minutes， single channel stone in 245 cases （88.6%）， multi-channel stone in 31 cases （11.4%）， calculi were removed in one stage 217 cases （78.6%）， two to take net in 36 cases （13.1%）， combined with the ESWL row net in 23 cases （8.3%）. Conclusion It is important of holding solid knowledge of ultrasonogrphy. It is two successful factor of the choice of the shortest distance of skin to renal and the direction of renipuncture tend to renal pelvis.[Keywords] Ultrasonogrphy; Renal calculi; Percutaneous nephrolithotomy. 　　随着医学科学的快速发展，微创、高效成为我们追求的目标。经皮肾镜碎石取石术是复杂性肾结石的主要治疗手段，但其需经肾实质做通道也使其具备很大的手术风险，如何顺利建立科学、高效的皮肾通道是手术成功的关键。我们于2007.10～2014.1间治疗肾输尿管结石276例，取得较好效果，报告如下。 一般资料 本组276例中，男142例，女134例;年龄最小18岁，最大75