导丝及穿刺针在经皮肾镜手术中新应用的初步体会.DOC

导丝及穿刺针在经皮肾镜碎石术中的新应用 王晓庆，侯宇川，姜凤鸣，陈岐辉，张海峰，王春喜（130021 长春，吉林大学第一医院？科室） [摘要]目的 探讨导丝及穿刺针在经皮肾镜手术中提高一次结石清除率的新应用。方法 19例鹿角形结石患者为研究对象。全身麻醉，超声引导下进行穿刺，穿刺成功后经穿刺针留置导丝，扩张穿刺通道至F18，留置Peel- away 鞘，置入肾镜，用钬激光将视野所能见结石击碎，清除结石。如X线或超声检查证实有肾盏结石残留，保留原穿刺通道，超声引导下经有残余结石的肾盏进行穿刺，穿刺成功后将导丝置入肾盂，X线证实导丝位于肾盂内，经第一个穿刺通道进境寻找导丝，沿导丝寻找肾盏内结石，必要时行肾盏颈口劈开。如因角度问题，沿导丝无法探及结石，撤出导丝，超声引导下用穿刺针直接穿到结石表面，并稍用力将肾盏内结石推入肾盂内进行碎石。结果 2例肾盏颈口较窄，行两通道碎石，其余15例均碎石成功，结石一次清除率达100%，平均手术时间83.2 min，术中估计出血量100 ml，术后下床活动时间14.6 d，术后住院日5.8 d。3例患者术后出现发热，无尿瘘、胸膜损伤、大出血等并发症出现。结论 经皮肾镜手术中，通过导丝及穿刺针的新应用，可显著提高一次结石清除率，尤其对于复杂性鹿角形结石患者，可减少多通道手术过程中引起的出血、术后感染等并发症。 [关键词]经皮肾镜；鹿角型结石；导丝；穿刺针 New application of guide wire and needle in percutaneous nephrolithotomy：the initial experience Wang Xiaoqing，Hou Yuchun，Jiang Fengming，Lu Ji，Chen Qihui，Zhang Haifemg，Wang Chunxi（Department of Urology，the first hospital of JiLin university，Changchun，130021 china） [Abstract]Objective To discuss the new application of guide wire and needle in improving the stone free rate of percutaneous nephrolithotomy. Methods 19 patients who had staghorn stones underwent percutaneous nephrolithotomy between October 2008 and December 2009 in our department were enrolled. The mean stone diameter was 3.4cm. General anesthesia， after retrograde ureteral catheterization in lithotomy position， the patients switched to prone position. We selected the middle or lower calyx as the puncture access. The puncture was guide by the ultrasound，dilated the puncture access and a 18F working sheath was advanced into the collecting system. A rigid 8.9F ureteroscopes was used with the Holmium laser. After the completion of fragmentation and removal of the stones which the rigid ureteroscope can access， we used X-ray or ultrasound to confirm the residual stones. If there are any resident stones in any calyx inaccessible with the rigid， another puncture was made guided by ultrasound to the calyx which has residual stones. Placed the guide wire through the needle to the pelvic， put the ureteroscope through the