斜仰卧位B超引导下经皮肾镜碎石取石术治疗嵌顿性输尿管上段结石

Treatment of Incarcerate Upper Ureteral Calculi in semi-supine position with ultrasound-guided percutaneous nephrolithotomy

目的 探讨斜仰卧位下经皮肾镜碎石取石术（PCNL）治疗嵌顿性输尿管上段结石的疗效及其优点.方法 分析本院2011年10月-2013年10月采用斜仰卧位下经皮肾镜碎石取石术（PCNL）治疗嵌顿性输尿管上段结石62例.手术均采用斜仰卧位,使患侧向上躯干冠状面与手术床呈30°- 45°,在B超引导下穿刺并建立操作通道,完成碎石机取石术,术后均常规留置双J管及肾造瘘管.结果 62例均为一期单通道碎石及取石,平均手术时间55min,肾造瘘管平均留置4d,术后住院时间5d,平均结石清除率96.8％.结论 斜仰卧位下经皮肾镜取石术治疗嵌顿性输尿管上段结石具有使患者及术者体位舒适、术中操作方便、手术更安全的优势,值得临床上应用推广.

Objectives To investigate the safety and feasibility of PCNL in treating incarcerate upper ureteral calculi in semi-supine position.Methods A restrospective investigation was conducted on 62 cases with Incarcerate Upper Ureteral Calculi,who were treated with percutaneous nephrolithotomy with ultrasound-guided from October 2011 to October 2013.The patients were placed in semi-supine position with flank elevated by 30° - 45 °.The puncture was made under the guidance B-type ultrasonography,and then Holmium laser was used for stone fragmentation.The stone debris was removed by irrigation.The double-J stent and nephrostomy tube were regularly placed after operation.Results All the 62 patients were achieved using one-stage percutaneous nephrolithotomy,and the mean operative time was 55 minutes,and average nephrostomy tube stay was 4 days,mean hospital stay was 5 days,primary stone clearance was achieved 96.8％.Conclusions PCNL in semi-supine position was an effective,safe and feasible treatment option for incarcerate upper ureteral calculi,which was helpful for anaesthetic inspection and comfortable for patients during the operation.