彩色多普勒超声引导经皮肾通道建立的应用价值

The establishment of percutaneous renal access under the guidance of color Doppler ultrasonography:its clinical application

目的探讨彩色多普勒超声引导下建立经皮肾通道的方法、成功率和安全性,评价超声引导在经皮肾镜取石术中的应用价值。方法回顾分析209例肾脏和输尿管上段结石患者行超声引导下成功建立皮肾通道并全过程监测、指导碎石取石。总结超声引导穿刺成功建立理想通道的经验体会和技巧。结果在彩色多普勒超声引导下成功建立经皮肾通道安全、有效。穿刺成功率99.0%(207/209),1次进针成功率94.7%(198/209),9例患者超声引导下2次穿刺成功,2例肥胖患者术前术中结合X线C臂进行定位,获穿刺成功。穿刺术中、术后未发生严重并发症。结论彩色多普勒超声引导穿刺建立经皮肾通道操作简单、成功率高、安全可靠是首选影像引导定位方法。

Objective To investigate the method of establishing the percutaneous renal channel under the guidance of color Doppler ultrasonography, to evaluate the success rate and safety of this technique, and to discuss its clinical application in percutaneous nephrolithotomy. Methods Under the guidance of color Doppler uhrasonography, percutaneous renal channel was successfully established in 209 patients with renal and upper ureteral calculi. The clinical data were retrospectively analyzed. The whole course of the removal of stones was monitored. The initial experience and the technical points were summarized. Results Under the guidance of color Doppler ultrasonography, an effective and safe percutaneous renal access was successfully established in all patients. The success rate of puncturing was 99% （207/209）. The success rate by single puncturing was 94.7% （198/209）. In 9 patients successful puncturing was accomplished with twice procedures. In two fat patients, successful puncturing was achieved with the help of C-arm radiography. No serious complications occurred during and after the treatment. Conclusion The operation of establishing a percutaneous renal access under the guidance of color Doppler uhrasonography is technically simple, clinically safe and reliable, with high success rate. Therefore, it should be regarded as the imaging-guided localizing method of first choice.