【摘要】 目的探讨侧卧位微创经皮肾镜钬激光碎石术的有效性和安全性。方法肾结石患者64例,男36例,女28例,先行患侧输尿管插管,改侧卧位,超声引导下肾穿刺,建立微创经皮肾取石通道,wolf8.5硬式肾镜寻找结石,钬激光粉碎,并利用灌注泵冲出。结果 61例为一期手术3,例因术中发现肾积脓留置造瘘管改二期手术,手术时间50～220 min(109 min±47.5 min),术中出血量约60～700 mL(196.4 mL±49.1 mL),一期手术结石清除率85.2%(52/61),二期手术结石总清除率95.3%(61/64),肾盂梗阻解除率100%,肾功不全及肾积水患者术后3月复查有不同程度的缓解,无胸膜及周围脏器损伤。结论侧卧位手术降低麻醉要求,提高了安全性,适合于呼吸及循环系统较差患者,同时便于超声引导穿刺,避免X线辐射,值得临床推广。更多还原

【Abstract】 Objective To investigate the effectivity and safety of minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy in the lateral position.Methods Sixty-four patients(36 males and 28 females) with kidney stones were performed ureter tube in diseased side,then changing to the lateral position with ultrasound-guided renal biopsy performed.Finally,minimally invasive percutaneous nephrolithotomy access was establishment and stone was observed with wolf 8.5 hard nephrolithotomy.The stone was crushed by holmium laser and pumped out by infusion.Results Among the 64 patients,61 were performed with first operation and 3 cases were underwent second stage surgery because of renal empyema lien.The mean operation time was 50~220 min(109 min±47.5 min).Blood loss was about 60~700 mL(196.4 mL±49.1 mL).The one-stage cure rate was 85.2%(52/61) and the second-stage was 95.3%(61/64).The renal pelvis obstruction discharge rate was 100%,renal insufficiency were recovered without no pleural and peripheral organ damage.Conclusion The lateral decubitus can reduce the anesthetic requirements,improve the operation safety and is suitable for patients with respiratory and circulatory system.It is worth to promote this skill due to suitable for ultrasound-guided puncture and avoiding the X-ray radiation.更多还原