基层医院经皮肾镜取石术的几点改进

A few improvements of percutaneous nephrolithotomy in basic hospital

目的探讨经皮肾镜取石术(PCNL)方法的改进,以更适合于基层医院。方法采取"十字交叉、先纵后横"超声定位,应用输尿管镜代替肾镜,改进穿刺通道大小、取石方法以及输尿管导管、肾造瘘管微处理后的经皮肾镜取石术治疗78例上尿路结石。结果所有手术均穿刺成功,2例肾结石中转开放手术,2例术后出血行超选择性肾动脉栓塞术治疗,无切肾、败血症、尿瘘、气胸、肠管损伤等严重并发症。结论改良后经皮肾镜取石术疗效满意、安全可靠、经济可行。

Objective To explore the improvements of percutaneous nephrolithotomy lithotripsy （PCNL） which were suitable for primary hospital. Methods 78 cases of upper urinary tract stones were treated under improved percutaneous nephrolithotomy lithotripsy, improvemerts including guiding by decussation process and first vertical then horizontal of ultrasound, using ureteroscopy instead of nephroscopy, improving methods of puncture channel size, lithotomy, and ureteral catheter, nephrolithotomy during the perioperative period. Remits All operations were performed successfully, two cases were transfered to open surgery, two eases suffered hemorrhage after operation were successfully treated by super-selective renal artery embolization, serious complications such as kidney loss, sepsis, urinary fistula, pneumothorax and bowel injury serious were not found. Conclusions The modified percutaneous nephrolithotomy were satisfactory, safe, reliable and economically viable.