基层医院开展超声引导下微创经皮肾穿刺取石术体会Experience of Ultrasound-Guided mPCNL in Primary Hospital
朱德才, 贺享军, 熊杰, 龚亚军, 郑中华
微创经皮肾穿刺, 超声引导, 治疗体会, 基层医院mPCNL, Ultrasound-Guided, Experience of Treatment, Primary Hospital
《Asian Case Reports in Surgery》, Vol.4 No.3, 2015-12-01
目的：探讨基层医院开展超声引导下微创经皮肾穿刺的可行性及安全性。方法：分析283例肾结石、输尿管上段结石在超声引导下微创经皮肾穿刺的临床资料，其中鹿角形结石32例，多发性肾结石82例，单发性肾结石85例；输尿管上段结石54例；肾结石并发同侧输尿管上段结石30例，合并肾功能异常151例。对术前评估、术中出血量、中转开腹原因、术后残石率、二次手术及住院天数进行分析。结果：283例患者均行一期碎石术，石清除率86.5%，平均手术时间110 min，平均出血量约200 ml，平均住院11 d，其中5例行输血，7例中转开放手术取石，全组患者无肾脏切除及手术后死亡病例。结论：基层医院开展超声引导下经皮肾穿刺取石术是可行的，但需充分准备才能保证医疗安全。
Objective: To investigate the feasibility and safety of ultrasound-guided minimally invasive per-cutaneous nephrolithotomy in primary hospital. Methods: The ultrasound-guided minimally inva-sive percutaneous renal biopsy clinical data of 283 patients suffering from kidney stones, upper ureteral calculi were analyzed, including staghorn calculi in 32 cases, multiple kidney stones in 82 cases, solitary kidney stones in 85 cases; upper ureteral calculi in 54 cases; kidney stones concur-rent ipsilateral upper ureteral stones in 30 cases, renal dysfunction in 151 cases. Preoperative as-sessment, intraoperative blood loss, laparotomy reason, postoperative residual stone rate, the second surgery and hospital stay were analyzed. Results: 283 patients underwent a period of li-thotripsy, stone clearance rate of 86.8%, the average operative time 110 min, average blood loss was 200 ml, the average hospital stay 11 d, of which 5 do blood transfusion, two cases of conversion to open surgery to stop bleeding. There are no patients with kidney resection or post- operative deaths in the whole group. Conclusion: Ultrasound-guided percutaneous stone removal surgery is feasible in primary hospital, and full preparation to ensure medical safety was necessary.