反向经皮肾-B超定位下输尿管软镜钬激光逆行建立皮肾通道的应用

Application of establishing percutaneous renal channel guided by flexible ureterscope with holmium laser lithotripsy and B-ultrasound

目的探讨B超定位下应用输尿管软镜钬激光逆行建立经皮肾通道的临床应用价值。方法回顾性分析盐城市第六人民医院泌尿外科2013年2月至2015年4月共33例患者，根据结石的特点，在B超定位下采用输尿管软镜钬激光逆行建立经皮肾通道，标准肾镜或微肾镜下钬激光碎石，必要时联合输尿管软镜检查各肾盏，将各盏残余结石以钬激光碎石后冲出。所有患者术后均留置肾造瘘管4~5 d、导尿管5~6 d，导尿管于肾造瘘管拔除后1~2 d拔除，留置双J管4~6周。术后随访3个月，复查KUB和肾功能（血-肌酐、尿素氮）。结果32例患者成功逆行建立经皮肾通道，一次通道建立成功率96.97%；平均建立皮肾通道时间为（21.27±6.75）min。一期手术清石率为93.75%，平均手术时间（87.68±15.48）min，平均术中出血量（53.56±37.08）mL，平均术后住院日（6.29±1.37）d，术后迟发性出血1例（3.13%），出血输血者1例（3.13%）。术后出现寒战、高热1例（3.13%），其余未见严重并发症。术后3个月复查：7例术前肾功能不全患者肾功能均好转。结论B超定位下应用软性输尿管镜钬激光逆行建立经皮肾通道行经皮肾镜碎石取石术安全、有效，具有定位精确、清石率高、并发症少等优点，是可选择的。

ObjectiveTo evaluate the clinical value of establishing percutaneous renal channel guided by flexible ureterscope with holmium laser and B-ultrasound. MethodsClinical data of 33 patients treated during Feb. 2013 and April 2015 were retrospectively analyzed. According to the characteristics of stones, the percutaneous renal channel was established guided by B-ultrasound, flexible ureterscope with holmium laser lithotripsy. After percutaneous nephrolithotomy （PCNL）, flexible ureterscope was used to check all renal calyces to remove the residual stones with holmium laser lithotripsy. The renal drainage tube, foley catheter, and double stent were indwelt for 4-5 days, 5-6 days, and 4-6 weeks after surgery respectively. All patients were followed up for 3 months and KUB and kidney function （Cr and Bun） were checked. ResultsWe successfully established percutaneous renal channel in 32 cases （96.97%） in （21.27±6.75） min on average. One-stage stone clearance rate was 93.75%, the average operation time was （87.68±15.48） min, the average blood loss was （53.56±37.08） mL, and the average hospital stay was （6.29 ±1.37） d. Delayed bleeding occurred in 1 case （3.13%）, blood transfusion occurred in 1 case （3.13%）, postoperative chills and fever occurred in 1 case （3.13%）. After 3 months, 7 cases with renal insufficiency were improved.ConclusionRetrograde percutaneous nephrostomy guided by flexible ureterscope with holmium laser and B-ultrasound is safe and effective, with advantages of high stone clearance rate and few complications.