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1、中国微创外科杂志2007年3月第7卷第3期ChinJMinInvSurg,March2007,Vo.l7.No.3257临床论著超声引导经皮肾穿刺的临床经验何立红李燕洪景范叶宁(广东省中山市小榄人民医院功能科,中山528415)摘要目的总结在经皮肾穿刺取石术(percutaneousnephrolithotomy,PCNL)中应用超声引导行经皮肾穿刺经验。方法在实时B超引导下用18G穿刺针经皮肾穿刺至肾盏或肾盂43例,将穿刺针道扩张后建立皮肾工作通道,镜下完成对肾盂及输尿
2、管上段结石的碎石和取石。结果本组43例中,肾穿刺成功率100%。1例经皮肾穿刺后出血不止改开放手术,建立皮肾工作通道成功率97.7%(42/43)。总的结石取净率为100%(42/42),其中38例一期取石成功,4例二期取石成功。无大出血及周围器官损伤。术后1个月B超或KUB未见结石残留。结论超声引导经皮肾穿刺成功率高、创伤小、安全、可靠。正确使用超声引导经皮肾穿刺技术是保证能顺利建立皮肾工作通道、完成对上尿路结石PCNL的关键。关键词超声引导;经皮肾穿刺;上尿路结石;PCNL+中图分
3、类号:R692.4;R693.4文献标识:A文章编号:1009-6604(2007)03-0257-02ClinicalexperienceofultrasoundguidedpercutaneousnephrostomyHeLihong,LiYan,HongJingfan,etal.DepartmentofFunction,XiaolanPeoplesHospital,Zhongshan528415,ChinaAbstractObjectiveTosummarizetheexp
4、erienceofultrasoundguidedpercutaneousnephrostomyduringpercutaneousnephrolithotomy(PCNL)underBultrasoundguidance.MethodsAultrasoundguidedpercutaneousnephrostomywasperformedin43casesbyusinga18gaugeneedle.Thenthepercutaneouspuncturewasexpandedforestablis
5、hingaworkingtunne.lUndernephroscope,stonefragmentationwascompletedintherenalpelvisandtheuppersegmentoftheureter.ResultsThesuccessrateofpercutaneouspuncturewas100%.Ofthe43cases,thepercutaneousworkingtunnelwassuccessfullyestablishedin42cases(977%),whileaco
6、nversiontoopensurgerywasneededin1casebecauseofuncontrolledhemorrhageafterpuncture.Theoverallstoneclearanceratewas100%(42/42),including38casesofstoneremovalononesessionand4casesoftwostagedclearance.Noseriouscomplications,suchasmassivehemorrhageorneighboring
7、organinjuries,wereencountered.ReexaminationswithBultrasonographyorKUBat1monthafteroperationshowednoresidualstones.ConclusionsUltrasoundguidedpercutaneousnephrostomyisminimallyinvasive,safe,andreliable.Properuseofthistechniqueiscrucialforasuccessfulperf
8、ormanceofpercutaneousnephrolithotomyinthetreatmentofupperurinarytractcalculus.KeyWordsUltrasoundguidance;Percutaneousnephrostomy;Upperurinarytractcalculus;Percutaneousnephrolithotomy经皮肾穿刺取石术(pe
