经皮肾镜取石术超声引导技巧与并发症分析

Analysis of complications related to percutaneous nephrolithotomy under guidance of utrasonography

目的回顾性分析90例超声引导下经皮肾镜取石术及穿刺并发症,探讨超声引导技巧。方法收集2007年12月至2010年12月因上尿路结石接受超声引导经皮肾镜取石术90例,回顾性分析穿刺过程及并发症的种类和产生原因,探讨超声引导穿刺的体会及技巧。结果本组90例患者中一次取石成功80例(58个肾结石,30例输尿管上段结石),取石成功率高达88.89%。本组患者在穿刺过程中有7例患者(7个肾结石)出现了穿刺并发症,并发症发生率7.78%。其中有4例患者发生了肾实质撕裂,有2例患者在肾盏取石过程中引发出血,1例患者在术后复查时有明显的腹膜后渗液。上述7例患者经对症处理后好转。结论 超声引导经皮肾镜取石术是一项安全有效的微创技术。穿刺前结合CT及静脉肾盂造影X线片选取最佳穿刺点、术中精确定位及正确训练患者呼吸运动以配合穿刺操作,可减少并发症的产生。

Objective To study the complications occurred after percutaneous nephrolithotomy（PCNL） under the guidance of ultrasonography in 90 cases of nephrolithiasis and skill for guidance of B type ultrasonography.Methods The piercing process of 90 cases with PCNL under ultrasound guidance during December 2007 to December 2010 was retrospectively analyzed.Their clinical data were reviewed and assessed on kind of complications,reasons for occurrence of complications and experience for piercing process.Results Among these cases,80 cases were cured after first time of operation（58 cases of renal calculus and 30 cases of upper ureteral calculus）,the rate of stone clearance was 88.89%.Complications happened in 7 cases after the puncture,and the rate of complication was 7.78%.Tear of renal parenchyma happened in 4 cases,renal hemorrhage occurred in 2 cases,retroperitoneal exudates existed in 1 case,and all of them were improved after symptomatic treatment.Conclusion PCNL under ultrasound guidance is an effective,safe and minimally invasive technique.The occurrence of complications may be reduced through selecting optimal puncture point with the help of CT scanning and IVP before operation,and precise orientation of operation and correct training of respiratory movement are helpful in reducing the occurrence of complications.