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目的探讨B超引导下经目标肾盏穹窿穿刺技术单通道行经皮肾取石术的安全性与疗效。方法 2012年6月‐2016年12月收治525例530侧上尿路结石,结石最大长径(27±8)mm。均在B超引导下从目标肾盏穹窿部穿刺,选择建立经皮肾单通道,采用钬激光碎石取石术。结果 525例530侧患者均穿刺成功建立单通道行经皮肾取石术,468侧行一期取石术(88.3%),40侧行二期取石术(7.5%)。穿刺时间3~25 min,平均(15±10)min。平均手术时间(60±35)min。手术中及手术后输血6例(1.1%)、术后发热9例(1.7%),无选择性肾血管栓塞止血。无血气胸、肝脾肠道损伤等严重并发症。术后1周及3个月复查腹部平片(KUB)或B超,508侧患者结石完全清除,22侧有少量结石残留(4.2%),结石总体清除率95.8%(508/530)。结论 B超引导下目标肾盏穹窿穿刺技术单通道行经皮肾取石术治疗上尿路结石安全、有效、并发症极少。
Objective To investigate the safety and efficacy of single-channel percutaneous nephrolithotomy guided by B-ultrasonography through the target calvaria. Methods From June 2012 to December 2016, 525 patients with 530 lateral upper urinary tract stones were treated. The largest diameter of the stones was (27 ± 8) mm. Under the guidance of B-ultrasound from the target calyceal fornix, select the establishment of percutaneous nephrostomy, Holmium laser lithotripsy. Results All the 525 cases of 530 patients underwent percutaneous nephrolithotomy successfully. One-stage percutaneous nephrolithotomy was performed on 465 sides, one stage was performed on the 468 side (88.3%), and the other was performed on stage 40 (7.5%). Puncture time 3 ~ 25 min, mean (15 ± 10) min. The average operation time (60 ± 35) min. Intraoperative and postoperative blood transfusions were performed in 6 cases (1.1%) and postoperative fever in 9 cases (1.7%). There was no selective renal embolization to stop bleeding. No blood gas chest, liver and spleen injury and other serious complications. Patients underwent KUB or B-ultrasound at week 1 and month 3 after operation. The stone was completely removed in 508 patients, with a small amount of residual stones on the 22 side (4.2%) and total stone clearance rate of 95.8% (508/530). Conclusions B-ultrasonography guided target calvaria puncture technique single-channel percutaneous nephrolithotomy for the treatment of upper urinary tract stones is safe and effective with few complications.