平卧位微穿刺造瘘经皮肾镜碎石取石术56例报告.pdf

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平卧位微穿刺造瘘经皮肾镜碎石取石术56例报告·论著周祥福高新温机灵肖翠兰陆佳荪孙颖浩微穿刺经皮肾镜碎石取石术(percutaneousnephrolithotomy，PCNL)已成为治疗肾结石及输尿管上段结石的主要手术方法。目前国内外多采用俯卧史堡婆拯处型盘查!!!!生!．!旦箜!!鲞箜!!塑鱼!!!!堕竺!!堕!!!坐!竺!!!!!!!!!!!塑!：!!温晓飞杨波陈兴屹【摘要】目的总结平卧位微穿刺造瘘经皮肾镜碎石取石术的临床经验。方法56例结石患者，结石位于左肾23例、右肾26例、输尿管上段7例。结石大小平均为2．6cm，单发结石17例，多发复杂性肾结石26例，肾铸形或鹿角形结石13例，最大铸形结石为5．7cm。伴重度肾积水者9例，轻中度肾积水者29例。患者取平卧位，患侧腰胁部垫高，B超引导下进行穿刺、扩张建立经皮肾微穿刺通道，采用输尿管镜行经皮肾镜碎石取石术。56例碎石取石术均成功。1例术中输血200ml，余55例均未输血。无一例出现严重并发症。一期结石取净40例(71．4％)，残留结石16例，其中9例二期手术取净，3例行体外冲击波碎石术治愈，4例未进一步处理。结论平卧位行经皮肾镜碎石取石术患者体位舒适，击碎的结石更易冲出，而且利于麻醉师观察患者，方便气管插管等抢救措施的实施。【关键词】经皮肾镜取石术；平卧ofXiang-fu，Email：[e-mail]【Abstract】【Keywords】Percutaneous结果Mini-percutaneousnephrolithotomyposition(reportcases)Xiang-fu+，GAOJi—ling，X1AOXiao-fei，YANGJia—sun，CHENAffiliatedObjective(mini—PCNL)inMethods71．4％(40／56)．ESWL87．5％(49／56)．Only作者单位：510630广州，中山大学附属第三医院泌尿外科(周祥福、高新、温机灵、肖翠兰)；上海同济大学附属东方医院中法泌尿外科中心(温晓飞、杨波、陆佳荪、陈兴屹、孙颖浩)通信作者：周祥福，Email：[e-mail]×1．7cm×7．2cm×4．3insupine56ZHOUXin，WENCui—lan，WENBo，LUXing—yi，SUNYing—hao．+De-Urology，ThirdHospitalSunYat-SenUniversity，Guangzhou510630，ChinaCorrespondingauthor：ZHOUToevaluatethetechniqueperformingmini—percutaneousAtotalnumberpatientswhounderwentPCNLforrenalureteralcalculiCarriedoutbyposition．Thelocatedleftkidney23cases，inright26and7cases，respectively．Se—hadsinglecalculuswhileothersmultiplecalculi．Thediameter2．6cm．Thirteenstaghornwithmaximaldimension5．7CB×cm．Severehydronephrosisfound9kidneysmildmoderate29kidneys．Theipsilateralflankraised1000mlsalinebagpadduringprocedure．Theskinpunctureddilatedunderguidanceultrasoundmini—PCNL．Re-suitsThesuccessfuloperation100％，whileprimaryclearanceResidualfclund16cases．TheadditionalPCNLsperformedcases．andresidualcompletelyremoved．ThreetreatedwillingPCNL．Therequiredbloodtransfusionprocedure．Therecomplicationpost—operation．Conclusionspositioniscomfortableacceptingfragmentsmucheasierwashthanotherpositionswell．Thisconvenientanesthetistobservepatientgeneralanesthesiaifneeded．nephrolithotomy；Supine728·partmentposition．up