本文選題：經(jīng)皮腎鏡 + 導(dǎo)絲��； 參考：《中國(guó)內(nèi)鏡雜志》2015年04期

【摘要】：目的探討導(dǎo)絲在經(jīng)皮腎鏡手術(shù)中提高一期結(jié)石清除率的臨床療效。方法 30例復(fù)雜性腎結(jié)石患者均經(jīng)導(dǎo)絲引導(dǎo)下來提高結(jié)石清除率。首先建立一穿刺通道,用超聲及氣壓彈道將視野內(nèi)結(jié)石擊碎并沖出體外。如超聲檢查示有腎盞結(jié)石殘留,應(yīng)保留原穿刺通道,超聲引導(dǎo)下經(jīng)有殘余結(jié)石的腎盞進(jìn)行穿刺,穿刺成功后將導(dǎo)絲置入腎盂,超聲證實(shí)導(dǎo)絲位于腎盂內(nèi),經(jīng)第1個(gè)穿刺通道進(jìn)鏡尋找導(dǎo)絲,沿導(dǎo)絲尋找腎盞內(nèi)結(jié)石。如因角度太小,沿導(dǎo)絲無法探及結(jié)石,則利用導(dǎo)絲建立第2穿刺通道進(jìn)行碎石。結(jié)果 2例因角度太小行兩通道碎石,余28例均一通道碎石成功,結(jié)石一次性完全清除,2例患者術(shù)后第6天出現(xiàn)血尿,無胸膜損傷、尿瘺、感染及大出血等并發(fā)癥出現(xiàn)。結(jié)論經(jīng)皮腎鏡碎石術(shù)中導(dǎo)絲的引導(dǎo)作用可顯著提高一期結(jié)石清除率,尤其對(duì)復(fù)雜性腎結(jié)石患者,可減少多通道碎石引起大出血、感染及尿瘺等并發(fā)癥的發(fā)生。
[Abstract]:Objective to investigate the clinical effect of guiding wire in one-stage stone removal during percutaneous nephroscopy. Methods 30 patients with complicated renal calculi were guided by wire guide to improve the stone clearance rate. First, a puncture passage was established, and the stones in the field of vision were smashed and rushed out of the body by ultrasound and pneumatic ballistics. If ultrasonic examination shows residual renal calcaneal stone, the original puncture passage should be retained. Guided by ultrasound, the guide wire should be inserted into the renal pelvis after successful puncture. The guide wire is located in the renal pelvis. Through the first puncture passage into the mirror to find the guide wire, along the guide wire to find the kidney calyceal stone. If the angle is too small to reach the stone along the guide wire, use the guide wire to establish the second puncture channel for lithotripsy. Results two cases were treated with two-channel lithotripsy because the angle was too small, and the remaining 28 cases were successfully treated with uniform channel lithotripsy. Hematuria, pleural injury, urinary fistula, infection and massive hemorrhage were found in 2 cases after 6 days of complete removal of stones. Conclusion during percutaneous nephrolithotripsy, the guiding effect of guided wire can significantly improve the clearance rate of primary calculi, especially for patients with complicated renal calculi, it can reduce the occurrence of complications such as massive bleeding, infection and urinary fistula caused by multichannel lithotripsy.
【作者單位】： 山東省臨沂市沂水中心醫(yī)院泌尿外科;
【分類號(hào)】：R699.2

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