超声引导“经肾盏窿-盏颈轴线两步穿刺法”经皮肾通道的建立--修改稿.doc

超声引导“经肾盏穹窿-盏颈轴线两步穿刺法”经皮肾通道的建立 余伟民 曹 君 阮 远 饶 婷 李浩勇 葛名欢 程 帆 张孝斌 【摘要】 目的 探讨超声引导下经皮肾通道建立的方法和临床疗效。方法 2013年6月-2015年6月，实施经皮肾镜手术（PCNL）212例，均在单纯超声引导下，以目标盏“穹窿-盏颈轴线”为最终穿刺方向，分两步进针建立经皮肾通道，收集通道建立相关数据并进行评价。结果 平均穿刺时间56.4±21.8秒，平均穿刺次数1.2±0.5次，一次成功占80.2%。经上，中和下组肾盏建立通道的比例分别为1.4%，90.6%和8.0%。43.4%皮肤穿刺点位于12肋下，50.5%位于12肋上，另6.1%位于12肋尖部。91.5%的手术均经单通道完成。通道建立过程中穿孔和通道出血需行血管栓塞各2（0.9%）例，总的单次结石清除率92.5%。结论 超声引导“经目标盏穹窿-盏颈轴线两步穿刺法”建立经皮肾通道是一种安全高效的PCNL通道建立方法。 【关键词】 经皮肾镜取石术；经皮肾通道；超声引导；肾盏轴线 Axis positioning combination of two steps punctures for solo ultrasound-guided access in percutaneous nephrolithotomy YU Weimin, CAO Jun, RUAN Yuan, RAO Ting, LI Haoyong, GE Minghuan, CHENG Fan, ZHANG Xiaobin. Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China Corresponding author: CHENG Fan, E-mail: 646064793@ 【Abstract】 Objective To explore the experiences and effects of ultrasound-guided access in percutaneous nephrolithotomy (PCNL). Methods The total of 195 patients who underwent 212 PCNLs was involved from June 2013 to June 2015. All of the accesses for PCNL were built under solo ultrasound-guided with axis positioning and two steps puncture. The related data of access was collected and analysis. Results The average puncture time for establishment of access was 56.4±21.8 seconds, the average puncture rate was 1.2±0.5 times and 80.2% puncture were success in one time. The proportion of access establishes in top, middle and lower calyces were 1.4%, 90.6% and 8.0%, respectively. With respect of skin puncture points, respective of 43.4%, 50.5% and 6.1% were located under, above and in the tip of the 12 rib. Total of 91.5% PCNLs were performed under one access and the one-time stone free rate was 92.5%. Each of 2 (0.9%) access related complications for perforation and embolism needed bleeding could be seen in this series. Conclusion Solo ultrasound-guided access with axis positioning combination of two steps puncture is a safe and efficient method for establishment of PCNL chan