超声引导“经肾盏穹窿盏颈轴线两步穿刺法”经皮肾通道的建立修改稿汇编.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 余伟民程 帆张孝斌 摘要 目的 探讨方法结果结论 【关键词；； 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?1.8o seconds, the average puncture rate was 1.2?.5d 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 channel. 【Key Words】 PCNL; Percutaneous renal channel; Ultrasound guide; Calyx axis 经皮肾通道的建立是实施经皮肾镜碎石取石术（percutaneous nephrolithotomy，PCNL）最为关键的步骤。超声引导经皮肾通道建立过程中缺乏传统X线透视引导的直观效果，需要一定的超声定位方法和穿刺进针技巧来实现安全高效的经皮肾通道建立[1,2]。本文分析了2013年6月～2015年6月在我院行PCNL的患者，所有手术均在单纯超声引导下完成经皮肾通道的建立，现将通道建立的经验和临床疗效报告如下。 资料与方法 一、一般资料 本组195例患者，年龄16～82岁，平均47.9岁。患者常规经泌尿系CT造影（CTU）确诊，部分肾功能不全患者经泌尿系CT平扫+结石成像+肾核素动态显像（ECT）确诊。所有手术由同一术者完成，患者均为术中