B超引导下微创经皮肾镜取石术建立经皮肾通道失败原因分析

Analysis of failure causes of establishing percutaneous renal channel in mini-percutaneous nephrolithotomy under B ultrasound guidance

目的：分析B超引导下微创经皮肾镜取石术建立经皮肾通道失败的原因，探讨建立经皮肾通道失败的防治对策。方法对2008-02～2012-12采用B超引导下微创经皮肾镜取石术治疗上尿路结石500例的临床资料进行回顾性分析。结果有42例由于穿刺不成功或穿刺成功后扩张时通道丢失未能建立经皮肾通道，但无穿刺及扩张相关大出血、肾周血肿、尿瘘、结肠及胸膜损伤等并发症发生。穿刺失败原因：体型肥胖10例，脊柱畸形6例，多囊肾3例，肾脏旋转不良3例；穿刺成功后扩张时通道丢失原因：有患侧肾开放取石史再次行经皮肾镜取石术7例，肾重度积水4例，鹿角形结石9例。结论体型肥胖、脊柱畸形、多囊肾、肾脏旋转不良、有患侧肾开放取石史、肾重度积水、鹿角形结石均是B超引导下微创经皮肾镜取石术建立经皮肾通道失败的原因，术前术者应充分考虑以上因素可能对手术产生的影响，认真设计经皮肾通道，可减少建立经皮肾通道失败的概率。

Objective To analyze the failure causes of establishing percutaneous renal channel in mini -per-cutaneous nephrolithotomy （ MPCNL） under B ultrasound guidance .Methods The clinical data of 500 patients with upper urinary tract calculus who underwent MPCNL under B ultrasound guidance were reviewed .Results The failure of establishing percutaneous renal channel found in 42 cases because of unsuccessful puncture or percutaneous chan-nel lost due to puncture expansion failure .There were no complications such as puncture or expansion bleeding , peri-renal hematoma, urinary fistula, colon and pleural damage.The causes of puncture failure included obesity （10 ca-ses）, the spinal deformity（6 cases）, polycystic kidney disease（3 cases）, kidney malrotation（3 cases）;the causes of renal channel lost included ill kidney having the history of open surgery for renal calculi （ 7 cases ） , severe hydrone-phrosis（4 cases）, staghorn stone（9 cases）.Conclusion Obesity, spinal deformity, polycystic kidney disease, kid-ney malrotation , ill kidney having history of open surgery for renal calculi , severe hydronephrosis , staghorn stone may be failure causes of establishing percutaneous renal channel in MPCNL under B ultrasound guidance , and carefully channel design can reduce the incidence rate of failure of establishing percutaneous renal channel .