细硬肾镜补充扩张法在建立经皮肾通道中的价值与操作技巧

The Supplement Dilation of the Fine Rigid Nephroscope Applied in Percutaneous Renal Access: Value and Operational Skills

摘要: 目的：探讨细硬肾镜补充扩张法在建立经皮肾通道中的作用。方法：本组82例患者行一期经皮肾通道建立，全麻后取俯卧位，人工肾积水条件下行患侧肾超声引导下目标盏穿刺，穿刺成功后Amplatz’s扩张器联合Alken’s金属套叠扩张器，依次扩张建立经皮肾镜碎石取石术工作通道。在扩张过程中用细硬肾镜检查经皮肾通道，确认通道扩张正常后继续扩张，发现问题及时处理。结果：本组82例患者均一期穿刺成功，并顺利建立87个皮肾通道。其中建立单通道者77例，双通道者5例。建立16F微通道者27例，24F标准通道者55例。所有重度积水者均建立标准通道。建立首个单通道平均时间20 min (15~40 min)。2例扩张过程中通道迷失，经输尿管导管向肾盂注入稀释美兰溶液，在镜下找到喷出蓝色液体的穿刺孔，插入斑马导丝，皮肾通道也得以成功建立。结论：细硬肾镜补充扩张法为经皮肾镜术提供了一种安全、有效的方法。

Abstract: Purpose: To explore the clinic efficacy of supplement dilation of the 6.4/8.0F fine rigid urtero-nephroscope in the percutaneous renal access. Methods: 82 patients with upper urinary calculi, were underwent one-stage percutaneous renal access after general aneathesia in the prone position, whose the ipsilateral aim calyx with artifical hydronephrosis was punctured by urologist under the ultrosonography guided. Guided-wire was inserted into the calyx through the needle’s sheath after successful puncture. The passage was gradually dilated to 16F or 24F by Amplatz’s dilator combinated with Alken’s metal telescope dilator over the wire. In order to immediately find and solve the problem during dilation, the tract was inspected by the 6.4/8.0F fine rigid ureteronephroscope over the guided-wire. Results: A total of 82 patients underwent percutaneous nephrolithotomy access, in which 77 PNLs were accessed by single tract (93.9%), 5 by double tracts (6.1%), in which 27 PNLs were accessed by 16F-tract (32.9%), 55 by 24F-tract (67.1%). They mean first accessing time were 20 min (range 15 to 40 min). During dilation, 2 cases with guided-wire drop out from calyx, the fine rigid ureteronephroscope fortunately found their tracts, by means injection methylene blue into renal pelvis through the ureteral stent. Conclusion: It is an effective and safety way that the supplement dilation of the fine rigid urteronephroscope applied to percutaneous renal access.