人工肾积水在输尿管插管困难的无积水肾结石经皮肾镜取石术中的应用

Application of articial hydronephrosis in percutaneous nephrolithotripsy under B-type ultrasound guidance for treatment of renal calculi without hydronephrosis

目的探讨经皮穿刺肾造瘘术中建立人工肾积水方法在输尿管插管困难的无积水肾结石治疗中的价值。方法对9例逆行输尿管插管困难的无积水肾结石患者,采用留置导尿并通过尿管灌注生理盐水,同时静脉给予速尿(呋塞米)20mg,形成人工肾积水,在B超引导下行肾盏穿刺,建立经皮肾盂通道行碎石取石术。左侧6例,右侧3例。铸型结石3例,单发结石4例,多发结石2例。结石长径2.0～4.5cm,平均3.5cm。结果9例均穿刺成功,术中出血40～400mL,平均150mL,建立通道时间10～25min,平均16min,无1例输血,无结肠、肝、脾及肺损伤。术后恢复好,留置尿管1周,拔除后7例可通畅排尿。结论对于无肾盂积水输尿管置管困难的肾结石患者,建立人工肾积水后在B超引导下行经皮肾盂穿刺成功率较高,是解决无积水肾结石微创手术的有效方法。

[ Objective ] To evaluate the efficacy and safety of management of renal stone in non-dilated collecting system by percutaneous nephrolithotripsy （PCNL） under ultrasound guidance. [ Method ] From August 2008 to April 2009, 9 cases of renal stone （7 men and 2 women;mean age, 42 years; age range, 35-72 years） in non-dilated col- lecting system were performed by percutaneous nephrolithotripsy. Among them the calculi were located on the left side in 6 cases, on the right in 3 cases; single in 4 cases, staghom calculus in 3 cases and multiple in 2. The mean diameter of the calculi was 3.5 cm （range, 2.0-4.5 cm）. A stent can not be inserted into the pelvis through cysto- scope. Furosemide was injected intravenously after a catheter was inserted into bladder and saline was instilled to dilate collecting system. Antegrade percutaneous access was obtained by B-type ultrasound guidance. A ultrasonic lithotrite was used to disintegrate and remove stone under direct vision. [ Results ] The percutaneous renaI access was successfully established under B-type ultrasound guidance in all patients, immediate phase I lithotripsy was per- formed in 9 cases. Operation time of the pereutaneous renal access ranged from 10 to 25 minutes, average timewas 16 minutes. Intraoperative bleeding was 150 （40-400） mL. None of cases was surpported by blood transfusion, se- vere complications did not occur during nephrolithotripsy. [ Conclusion ] The management of renal stone in non-di- lated collecting system using PCNL appears to be efficacious and safe under B-type ultrasound guidance.