彩超引导穿刺在微创经皮肾镜碎石取石术中的临床应用

The clinical application of endoscopic minimally percutaneous nephrolithotomy under the color Doppler ultrasound guided

目的:探讨应用彩超引导下经皮肾脏穿刺在微创经皮肾镜碎石取石术(mini percutancous nephrolithotomy,MPC-NL)中的临床应用价值。方法:对18例肾结石患者,利用彩色超声定位,建立经皮肤至肾脏通路,实时引导穿刺套管针穿刺至肾盏、肾盂及结石部位,引导扩张器建立肾镜工作通道,然后以肾镜应用气压弹道和钬激光碎石,完成微创下对肾结石及输尿管上段结石的碎石取石。结果:18例肾结石患者中经皮肾脏穿刺于肾下盏建立通道14例,肾中盏建立通道4例。一次性建立通道成功17例,成功率为94.45%(17/18),二次穿刺建立通道成功1例;一次经肾镜碎石取石成功16例,结石清除率为88.9%(16/18),结石残留2例,残留率为11.1%。18例均未出现胸膜、腹腔脏器损伤、肾脏穿通伤、肾实质撕裂、大出血等并发症。结论:采用彩色超声引导实施MPCNL技术,具有定位准确、高效安全、无辐射等优点,且术中可监测治疗,因此是保证MPCNL手术成功的关键,具有十分重要的临床应用价值。

Objective： To evaluate the clinical value of endoscopic minimally percutaneous nephrolithotomy（mini percutancous nephrolithotomy,MPCNL） with color Doppler ultrasound guided.Methods： Using ultrasound-guided,to establish of channels through the skin to the kidney,and real-time guided puncture needle to the parts of the renal pelvis and stones,and then applied nephrolithotomy holmium laser lithotripsy ureteral stones,nephrolithiasis.Results： The patients in 18 cases of percutaneous renal channel in the lower renal calices established in 14 cases,and middle renal calices established in 4 cases;one channel successfully established in 17 cases,the success rate was 94.45%（17/18）,secondary 1 case to establish a successful puncture channel;by the nephrolithiasis lithotripsy in 16 cases successfully,clearance rate was 88.9%（16/18）,2 cases because of severe adhesions and left residual calyceal stones left residual rate was 11.1%（2/18）,18 cases were not thoracic and abdominal organ damage,kidney penetrating injury,bleeding and other severe complications.Conclusion： The treatment of the MPCNL under the color doppler ultrasound guided appears to be positioning accuracy,efficiency and security,no radiation,and surgery treatment can be monitored,it is to ensure MPCNL key to successful operation,and has very important clinical value.