B超引导经皮肾穿刺在经皮肾镜取石术中的技巧

Application of percutaneous puncture with B-type ultrasonography guidance in percutaneous nephrolithotripsy for treatment of renal stone

目的探讨B超引导下建立经皮肾通道在经皮肾镜取石术中的临床应用价值。方法2006年9月～2008年6月,376例肾结石患者在B超引导下穿刺目标肾盏,建立皮肤肾脏通道,肾镜下采用气压弹道或联合超声取石术。对B超穿刺时间、手术时间、手术并发症、结石清除率进行分析。结果376例患者均穿刺成功建立皮肤肾脏通路,367例行一期取石术,9例行二期取石术。穿刺时间1～30min,平均(15±11)min,8例患者术中输红细胞悬液2～6u,1例气胸。术后1周复查,305例患者排净结石,71例有结石残余,结石清除率81.1%。结论B超引导下经皮肾穿刺,临床简便可行,无放射性损伤,穿刺成功率高;B超监视还具有提高结石清除率、有效减少结石残留的优越性。

[Objective] To evaluate the efficacy of management of renal stone by percutaneous nephrolithotripsy （PCNL） under B type ultrasonography guidance. [Method] From Sept. 2006 to June 2008, 376 cases of renal stone accepted percutaneous nephrolithotripsy. Percutaneous access was constructed by B-type ultrasound guidance. A combination of pneumatic and ultrasonic lithotrite was used to disintegrate and remove stones under direct vision. Clinical data including operation nephron puncturation time, complications and stone free rate were analyzed, retrospectively. [Results] The percutaneous renal access was successfully established under B-type ultrasonograpy guidance in all the patients, immediate phase Ⅰ lithotripsy was performed on 367 cases and delayed phase Ⅱ lithotripsy on 29 cases. Puncturation time ranged from 1 to 30 minutes, average time was （15±11） minutes, 38 cases were supported by blood transfusion ranged from 400 mL to 1,200 mL, 1 case had hydropneumothorax, but no other severe complications occured during nephrolithotripsy. Stones were cleared in 305 out of 376 cases （81.1%） during immediate phase I lithotripsy, residual stone fragment was found in 71 cases who received second PCNL or adjuvant extracorporeal shock wave lithotripsy. [Conclusion] It is effective and safe that percutaneous nephrolithotomy for renal calculi via percutaneous renal access guided by B ultrasonography. It has adventages of diminished residual stone and no radioactive damage.