B超引导下建立皮肾取石通道困难时的应对措施

Countermeasures of the difficulties in the establishment of percutaneous nephrolithotomy standard channel under the guidance of the B-type ultrasound

目的探讨B超引导下建立F24标准皮肾取石通道出现困难时的应对措施。方法复杂肾结石9例。其中肾结石无积水者8例,重度肾积水者1例。B超引导下建立取石通道均出现困难。4例无肾积水者经输尿管导管注入美兰注射液,再以输尿管镜观察,寻找集合系统;2例无肾积水者改X线C型臂监视下,调整扩张器深度,配合输尿管镜观察;重度肾积水者以输尿管镜沿导丝寻找集合系统;另2例改小切口手指引导下直接穿刺肾脏并扩张。结果 7例患者均通过相应方法找到集合系统,并进一步扩张成功建立F24经皮肾取石通道;2例小切口手指引导下成功建立F24经肾取石通道。结论无积水及重度积水肾结石较难建立取石通道。经输尿管导管注入美兰、改X线C型臂透视下操作或输尿管镜沿导丝寻找,多可进入集合系统,成功建立经皮肾取石通道。小切口手指引导下建立经肾取石通道简单易行,可作为避免转开放手术的最后补救措施。

Objective To investigate the countermeasures of the difficulties for establishing F24 percutane- ous nephrolithotomy standard channel under the guidance of the B-type ultrasound. Methods Nine patients of com- plicated renal calculi were enrolled in this study, of which 8 were without hydronephrosis and one was with severe hy- dronephrosis. Difficulties were counted in the establishment percutaneous nephrolithotomy standard channel. Four pa- tients without hydronephrosis were injected with methylene blue through ureteral catheter, and then observed by ure- teroscope to find the collection system. Two patients without hydronephrosis had the depth of the expansion device ad- justed under the guidance of C-Arm X-ray System, with ureteroscopic observation. For the patient with severe hydro- nephrosis, collection systems were found by ureteroscope along the guide wire. The other two patients suffered direct puncture of the kidney and expansion under finger reduction by mini-incision. Results Through corresponding coun- termeasures, the collection system of the seven patients were found, and the F24 percutaneous nephrolithotomy stan- dard channel were successfully established. Conclusion The percutaneous nephrolithotomy channel is difficult to be established in patients without hydronephrosis and those with severe hydronephrosis. The injection with methylene blue through ureteral catheter, guidance of C-Arm X-ray System or ureteroseopy can help fred the collection system, then leads to the successful establishment of percutaneous nephrolithotomy channel. Finger reduction by mini-incision for the establishment of stone channels is simple to be operated and can be used to avoid open surgery as the final remedy.