标准通道辅助微通道经皮肾镜碎石术治疗复杂性结石的护理

Study on nursing with standard-PCNL auxiliary combined with mini-PCNL in the treatment of complicated calculi

目的探讨标准通道辅助微通道经皮肾镜碎石术（PCNL）治疗复杂性结石的优势及护理措施。方法回顾性分析河北大学附属医院2010年7月至2012年7月56例复杂性结石患者行标准通道辅助微通道PCNL的治疗及护理。结果本组56例患者均成功建立标准通道及微通道并一期取净结石，5l例完全取净结石，结石清除率91％，残留小结石5例，行体外冲击波碎石（ESWL）治疗后结石排净。手术时间40-100min，平均手术时间78min。术中出血量50～200mL，平均130mL。住院时间5-10d，平均住院时间7d。术后出血、感染、双J管移位等并发症经保守治疗后痊愈。全部病例随访3～18个月，无迟发型出血、严重感染等并发症发生。结论标准通道辅助微通道经皮肾镜碎石术治疗复杂性结石，具有结石清除率高、手术时间短、术中出血少、并发症少等优点。细致周到的护理是手术成功及患者康复的重要保障。

Objective To investigate the nursing approaches with standard-PCNL auxiliary combined with mini- PCNL in treating complicated calculi. Methods Retrospective analysis were used in 56 cases with complex calculi in our hospital from 2010 July to 2012 July treated with standard-PCNL assisted with mini-PCNL. Results Of the 56 patients, all were successfully established standard tract and mini tract and one stage procure were take on all cases, 51 cases were completely removed the stone, the stone free rate（SFR） was 91%, 5 cases of residual calculi which extracorporeal shock wave lithotripsy （ESWL） were used in 5 cases. Operative time were 40-100 min, with a average of 78 min. Intraoperative blood loss was 50-200 mL, average 130 mL. The hospital staying time were 5-10 d, the average hospitalization time was 7 d. Postoperative bleeding, infection, double J cather shifting complications recovered after conservative treatment. All patients were followed up for 3-18 months, the results indicated that there was no delayed hemorrhage, severe infection. Conclusion Our results show that there are many advantages of applying standard-PCNL combined with mini-PCNL in treating complicated calculi, with a high SFR, short operation time, less bleeding. Carefully nursing care is important to approval the success rate of operation and rehabilitation of patients.