患者坐位超声引导下经皮肾穿刺造瘘术的临床应用

Clinical application of ultrasound-guided percutaneous nephrostomy in patients'sitting position

目的对患者坐位超声引导下行经皮肾穿刺造瘘术(Percutaneous nephrostomy,PCN)的临床资料进行总结,探讨患者坐位超声引导下PCN的可行性。方法回顾性分析2017年1月~2018年12月对上尿路积水患者16例(27侧)进行PCN治疗,对比PCN前、后肾功能的变化。结果对梗阻性肾积水(Hydronephrosis),嘱患者取坐位,超声引导下PCN,满意放置UrovisionR造瘘管,成功率96.3%(26/27)。局麻下操作,对患者的呼吸、血流动力学影响小,未出现严重并发症,患者容易耐受,PCN前、后肾功能变化差异有统计学意义(P<0.05)。结论坐位实时超声引导PCN成功率高、安全、可靠,手术操作者更舒适,患者也更容易耐受,合理选择PCN通道是操作成功的关键。

Objective To summarize the clinical data of ultrasound-guided percutaneous nephrostomy(PCN)in patients'sitting position,and discuss the feasibility of ultrasound-guided PCN in patients'sitting position.Methods 16 patients with upper hydroureterosis(27 sides)from January 2017 to December 2018 were retrospectively analyzed and treated with PCN,and renal function before and after PCN was compared.Results For obstructive hydronephrosis,patients were instructed to adopt sitting position,ultrasound-guided PCN was conducted,UrovisionR fistulation tube was satisfactorily placed,and the success rate was 96.3%(26/27).The operation under local anesthesia exerted little respiratory and hemodynamic influence on the patients,saw no occurrence of serious complications,and the patients had good tolerance.There was statistically significant difference in the renal function before and after PCN(P<0.05).Conclusion PCN guided by real-time ultrasound in patients'sitting position has high success rate,and it is safe and reliable.With it,the operator will be more comfortable and the patient will be more tolerant.Reasonable selection of PCN channel is the key to successful operation.