改良侧卧位微创经皮肾镜气压弹道碎石取石术67例报告

改良侧卧位微创经皮肾镜气压弹道碎石取石术67例报告

赵延春,陈敏,向芹,李瑞斌,王勤军

中国葛洲坝集团中心医院

收稿日期:2011-07-22 修回日期:2012-01-11 出版日期:2012-06-15 发布日期:2012-06-15
通讯作者: 向芹

Percutaneous Nephrolithotomy with atmospheric pressure ballistic trajectory gravel treatment in the improvement Lateral Position: Report of 67 Cases

Received:2011-07-22 Revised:2012-01-11 Published:2012-06-15 Online:2012-06-15
Contact: Xiang Qin

赵延春,陈敏,向芹,李瑞斌,王勤军. 改良侧卧位微创经皮肾镜气压弹道碎石取石术67例报告[J]. .

摘要/Abstract

摘要： 【摘要】目的：探讨改良侧卧位微创经皮肾镜取石术(pereutaneous nephrolithotomy,PCNL)的优越性与疗效。　方法：2009年7月-2011年2月我院67例上尿路结石，取改良侧卧位（取截石位向健侧转体60°侧卧)，建立微创经皮肾通道，输尿管导管注水、移动配合输尿管镜气压弹道碎石、灌注泵冲洗结合取石钳取石。结果：除3例改用俯卧位完成PCNL外，余64例均顺利完成手术，一期手术51例，二期手术13例，无中转开放手术。手术时间43~230 min，(142.4土34.1)min，一期手术结石清除率86.6% (58/67)。无因患者体位不适中断手术及气胸及肝脾等脏器损伤并发症的病例，所有病例均已解除肾积水。63均采用单通道进行，4例采用双通道顺利取出结石。11例术后配合药物排石及ESWL碎石排净。结论：在治疗高龄患者、麻醉监测、安全性、患者舒适度以及提高手术效率等方面有一定的优越性。

关键词: 　经皮肾镜取石术, 气压弹道碎石, 改良侧卧位

Abstract: Abstract:Objective To evaluate the superiority and efficacy of percutaneous nephrolithotomy (PCNL) in the improvement lateral position.　 Methods A total of 67 patients were treated with PCNL in our hospital between July 2009 to February 2011. The patients were placed in the improvement lateral position(with Turning the lithotomy position 60 degrees to the lateral position. The Position of the cathter and then Pneumatic lithotripsy was used for stone fragmentation. The stone debris was removed by irrigation.　 Results Among the 64 cases, 51 were cured with the first operation, the other 13 received catheterization in the firstprocedure. None of the patients were converted to opensurgery. The mean operation time in this series was (132.4±34.1) min. The one stage cure rate in our patientswas 86.6% (58/67). None of the cases had massive blood loss, or injuries to the pleura and otherorgans. Follow-upwas available in 21 cases for1 to all cases have been taken off the water, 63 cases by a single channel, 4 cases by double channel, 11 cases treated by traditional Chinese medicine and ESWL had no residual stones Conclusions There are some advantages in elderly patients, surveillance, security, comfort and improve operation efficiency of the patients in the improvement lateral position.　

Key words: Percutaneous nephrolithotomy, Atmospheric pressure ballistic trajectory gravel treatment, improvement lateral position