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ID:22299033
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时间:2018-10-28
《微创经皮肾镜取石治疗上尿路结石45例体会》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、微创经皮肾镜取石治疗上尿路结石45例体会徐钱1热吾力(通讯作者)2(1江苏省南通市第三人民医院泌尿外科226000)(2新疆伊犁哈萨克自治州伊宁县人民医院泌尿外科835100)【摘要】目的:评价微创经皮贤镜取石(minimallyinvasivepercutaneousnephmlithotomy,MPCNL)治疗上尿路结石的疗效。方法:2013年11月至2015年3月45例上尿路结石,其中肾结石33例,输尿管上段结石12例,在X线透视或B超监视下穿刺建立皮肾通道F16,WOLFF8/9.810°输尿管硬镜直
2、视下进入肾脏集合系统,找到结石,以钬激光碎石,功率设置为2.5」/20Hz,最后留置F16肾造瘘管。结果:45例病人中一期碎石41例,二期碎石4例。其中2例双侧肾结石分两期手术成功,2例穿刺后发现脓液流出,予留置肾造瘘管,抗感染后二期取石成功。手术时间50〜125min,平均时间80min。42例取尽结石,结石清除率达93.3%,3例术后复查出现残留结石,联合体外震波碎石及药物治疗后结石排出。1例术后出现感染性休克,转入重症病房监护室(ICU)治疗好转后出院。结论:微创经皮肾镜取石是治疗上尿路结石的有效手段,具有创伤
3、小,出血少,并发症低,手术结石清除率高,术后恢复快等优点。【关键词】微创经皮肾镜;上尿路结石【中图分类号】R615【文献标识码】A【文章编号】2095-1752(2015)28-0187-02Experienceof45percutaneousnephrolithotomycasesforthetreatmentofupperureteralcalculusXuQianl,ReWuli2(Communicationauthor).DepartmentOfUrology,NanTongThirdPeople'sHosp
4、ital226000China【Abstract]objectiveToevaluatetheemcacyandsafetyofminimallyinvasivepercutaneousnephrolithotomy(MPCNL)inthetreatmentofupperureteralcalculus.MethodsFromNovember2013toMarch2015,45casesofupperurinarycalculus(12casesofthemwereupperureteralcalculusand33
5、caseswererenalcalculus)underwentpunctureundertheguidanceofBultrasonographyorX-ray.ApercutaneousF16workingchannelwasmade,andstoneswerefoundunderwolfF8/9.810°rigiduretemscope.Thenthestoneswerebrokenbyholmiumlaserandremoved,powerissetto2.5J/20Hz.Finally,anephm
6、stomytubewasplacedintheincision.ResultsOne-stageoperationwasperformedin41casesandtwo—stageoperationwasperformedin4cases.2casesofbilateralrenalcalculuswereoperatedsuccessfullyintwostages;theoutflowofpuswasfoundin2patientsafterpuncture,anephmstomytubewasplacedint
7、heincision.Stoneclearancewasachievedafterthetreatmentofinfection.Theoperationtimewas50—125min(average,80min).Completestoneclearancewasachievedin42caseswithanoverallclearancerateof93.3%.Threecasesofresidualrenalstonesweresuccessfullymanagedbyextracorporealshockw
8、avelithotripsyandmedication-Onecaseofsepticshockoccurredafteroperation.Hewastransferredintointensivecareunitanddischargedaftertheimprovementofshocktherapy.ConclusionsMPCNLin
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