[1]李永发,阮安明,杨钧显,等.“刚柔精准穿刺法”在超声引导经皮肾镜术中的应用[J].中华腔镜泌尿外科杂志(电子版),2018,12(01):8-12.[doi:10.3877/cma.j.issn.1674-3253.2018.01.003 ]
　Li Yongfa,Ruan Anming,Yang Junxian,et al.The application of "rigid and flexible precision puncture" in ultrasound-guided percutaneous nephrolithotripsy[J].,2018,12(01):8-12.[doi:10.3877/cma.j.issn.1674-3253.2018.01.003 ]
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“刚柔精准穿刺法”在超声引导经皮肾镜术中的应用()
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中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
12卷
期数:
2018年01期
页码:
8-12
栏目:
临床研究
出版日期:
2018-01-31

文章信息/Info

Title:
The application of "rigid and flexible precision puncture" in ultrasound-guided percutaneous nephrolithotripsy
作者:
李永发1; 阮安明1; 杨钧显1; 王少刚2; 高强利1
430081 武汉科技大学附属普仁医院泌尿外科1；430030 武汉，华中科技大学同济医学院附属同济医院泌尿外科2
Author(s):
Li Yongfa1;  Ruan Anming1;  Yang Junxian1;  Wang Shaogang2;  Gao Qiangli1.
1Department of Urology, the Affiliated puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, China; 2Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
关键词:
经皮肾镜;  超声;  肾结石;  刚柔穿刺;  精准医疗
DOI:
10.3877/cma.j.issn.1674-3253.2018.01.003
摘要:
目的 探讨“刚柔精准穿刺法”在超声引导经皮肾镜术中的穿刺特点及应用价值。方法 回顾性分析2013 年12 月至2015 年12 月352 例在武汉市普仁医院泌尿外科行经皮肾镜术的患者资料，通过术前泌尿系CT 三维重建及腹部平片（KUB）检查，明确肾盂、肾盏结构及结石分布情况，并术前常规超声验证，进而设计最佳穿刺路径，术中采用“刚柔精准穿刺法”超声引导定位穿刺，建立16～20 F 通道，使用12.5 F 微创肾镜，腔内采用气压弹道联合60 W 科医人钬激光碎石，手术结束前再次超声检查结石残留情况，如平行盏有明显结石残留则采用针刺辅助或多通道取石。患者年龄21～80 岁，平均（44±10）岁，单发结石79 例，单侧多发结石212 例，鹿角形结石61 例；结石长径1.6～5.7 cm，平均为（2.4±0.5）cm。 结果 本组352 例患者全部精确穿刺预定目标肾盏穹窿成功，建立通道满意，1 例因术中发现肾盂积脓仅留置肾造瘘管改II 期取石，I 期双通道取石16 例，II 期原通道取石7 例。超声引导穿刺第1 针穿刺成功率97.7%（344/352），第2 针穿刺成功率100%，穿刺时间1.0～3.0 min，平均（1.1±0.4） min，通道建立时间2.0～5.0 min，平均（3.1±1.0） min，手术时间10～80 min，平均（32±12） min。本组未出现血气胸、肝脾肠管损伤等手术并发症，输血3 例（0.85%），术后延迟出血2 例（0.57%），均予卧床休息及高蛋白饮食1 周内恢复。术后3～4 d 复查KUB 平片，I 期结石清除率：单发结石100%（79/79）；多发结石91.5%（194/212）；鹿角形结石81.9%（50/61）；总体91.8%（323/352）。结论术中在超声引导下“刚柔精准穿刺法”可实现精准穿刺，值得临床推广应用。

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备注/Memo

备注/Memo:
基金项目：双镜联合治疗复杂性肾结石临床疗效的评估项目（WX15C01）
通讯作者：高强利，Email：12416514@qq.com
更新日期/Last Update: 2018-02-25