不使用穿刺架超声引导经皮肾镜取石术的体会

The experience of ultrasound guidance without puncture frame in pereutaneous nephrolithotomy

目的探讨不使用穿刺架超声引导经皮肾穿刺行经皮肾镜取石术（PCNL）的方法及效果。方法 2010年10月至2014年8月,我们不使用穿刺架超声引导经皮肾穿刺方法的改进,行经皮肾镜取石术病例106例,对每处建立经皮肾通道的穿刺成功率、手术出血情况、术后并发症等进行回顾性分析。结果 106例患者建立经皮肾通道132处,穿刺成功率95.5%（126/132）;6处术中寻找残余结石进行二次穿刺未成功,联合C-臂机穿刺成功;术后输血（200~400mL）5例,无选择性肾动脉栓塞止血;胸腔积液7例,1例需闭式引流;术后发热9例,无感染性休克及不良预后发生;无肺脏及其他内脏损伤等严重并发症。结论不使用穿刺架超声引导经皮肾穿刺方法的改进,经皮肾穿刺过程中操作简便、迅速、准确、经济,成功率高,有效地降低了穿刺的难度,可在基层医院推广。

Objective To explore the safety and availability of ultrasound guidance without puncture frame in pereutaneous nephrolithotomy.Methods During Oct.2010 and Aug.2014,106 cases who received pereutaneous nephrolithotomy under the guidance of ultrasound without puncture frame were retrospectively studied.The success rate,bleeding and complications were analyzed.Results A total of 132 channels were established in the 106 cases.The success rate of puncture was95.5%（126/132）.Of all channels,6 failed to find the residual stone and needed the guidance of C-arm X-ray.Five patients needed blood transfusion（200-400 mL）after the operation.No case needed selective renal arterial embolization.Pleural effusion occurred in7 cases,and1 needed to close drainage.Postoperative fever occurred in9 cases,but no infectious shock happened.No serious complications were observed.Conclusions The technique of ultrasound guidance without puncture frame in pereutaneous nephrolithotomy is rapid,accurate,economical,and can make puncture simple.It is worth of promotion in primary hospitals.