摘要
目的探讨可视穿刺系统在处理肾下盏结石中的应用价值。方法收集2016年8月至2016年12月我科收治的18例肾下盏结石患者的临床资料,所有患者均通过可视穿刺系统建立通道并碎石,术后1周通过体外物理振动排石机辅助排石,术后3周观察结石清除情况。结果所有18例患者均成功建立通道,17例患者扩张至F8通道碎石,另外1例术中发现下盏盏颈狭窄合并感染,扩张通道至F18后留置造瘘管引流,1周后二期行盏颈内切开并碎石。结石一次性完全处理共17例,术后未留置肾造瘘管及输尿管支架管。17例患者平均手术时间78.6(52~95)min,平均术中出血量29(20~45)ml,术后平均住院时间5.6(4~7)d。术后3周复查平片所有患者结石均消失。患者术后出现高热患者2例,无胸膜损伤、肠管损伤、大出血等并发症出现。结论可视穿刺系统在处理肾下盏结石出血风险小,尤其对于无积水肾结石有较高的临床应用价值,值得推广。
Objective To analyze the clinical value of the visual puncture system for the treatment of lower calyx stones. Methods Eighteen patients with lower calyx stones admitted to our department from Agust 2016 to December 2016 were enrolled in this study. All the above 18 patients got percutaneous renal access successfully and received the holmium laser lithotrity. And the physical vibration lithecbole treatment a week later was undergone as well. Clearance rate of stones was observed 3 weeks after operation. Results Passages of 17 cases were dilated to 8 F and then one-stage percutaneous nephrolithotomy was done. Passage of the other one case was dilated to 18 F because of the concurrent infection with calyx carotid stenosis,and an 18 F nephrostomy tube for drainage was retained,until the incision of renal calices and lithotomy was carried out1 week later. One-stage lithotripsy was completed successfully in the 17 patients with no nephrostomy tube for drainage. The average operation time was 78.6 min.The mean estimated intraoperative blood loss was 29 ml. The mean postoperative hospital stay time of the patients was 5.6 d. All the stones of the above cases disappeared 3 weeks after operation from the KUB review. Fever occurred in 2 patients after operation. No massive haemorrhage,pleural injury,intestinal injury or other complications occurred. Conclusion Visual puncture system in treatment of lower calyx stones has lower risk of bleeding,which is suitable especially for the management of renal stones in non-dilated collecting systems and is worth of popularization.
作者
龚小新
杨勇
陈从波
黄力
李昊
王黎
姚启盛
GONG Xiao-xin;YANG Yong;CHEN Cong-bo;HUANG Li;LI Hao;WANG Li;YAO Qi-sheng(Department of Urology and An- drology, Taihe Hospital Affiliated to Hubei University of Medicine, Shiyan 442000, Hubei, Chin)
出处
《中国现代手术学杂志》
2017年第4期316-318,共3页
Chinese Journal of Modern Operative Surgery
关键词
可视化穿刺系统
碎石术
激光
肾结石
visual puncture system
lithotripsy, laser
kidney calculi