【摘要】 目的总结在经皮肾穿刺取石术(percutaneous nephrolithotomy,PCNL)中应用超声引导行经皮肾穿刺经验。方法在实时B超引导下用18G穿刺针经皮肾穿刺至肾盏或肾盂43例,将穿刺针道扩张后建立皮肾工作通道,镜下完成对肾盂及输尿管上段结石的碎石和取石。结果本组43例中,肾穿刺成功率100%。1例经皮肾穿刺后出血不止改开放手术,建立皮肾工作通道成功率97.7%(42/43)。总的结石取净率为100%(42/42),其中38例一期取石成功,4例二期取石成功。无大出血及周围器官损伤。术后1个月B超或KUB未见结石残留。结论超声引导经皮肾穿刺成功率高、创伤小、安全、可靠。正确使用超声引导经皮肾穿刺技术是保证能顺利建立皮肾工作通道、完成对上尿路结石PCNL的关键。更多还原

【Abstract】 Objective To summarize the experience of ultrasound-guided percutaneous nephrostomy during percutaneous nephrolithotomy(PCNL) under B-ultrasound guidance. Methods A ultrasound-guided percutaneous nephrostomy was performed in 43 cases by using a 18-gauge needle.Then the percutaneous puncture was expanded for establishing a working tunnel. Under nephroscope,stone fragmentation was completed in the renal pelvis and the upper segment of the ureter.Results The success rate of percutaneous puncture was 100%.Of the 43 cases,the percutaneous working tunnel was successfully established in 42 cases(97.7%),while a conversion to open surgery was needed in 1 case because of uncontrolled hemorrhage after puncture.The overall stone clearance rate was 100%(42/42),including 38 cases of stone removal on one session and 4 cases of two-staged clearance.No serious complications,such as massive hemorrhage or neighboring organ injuries,were encountered.Re-examinations with B-ultrasonography or KUB at 1 month after operation showed no residual stones.Conclusions Ultrasound-guided percutaneous nephrostomy is minimally invasive,safe,and reliable.Proper use of this technique is crucial for a successful performance of percutaneous nephrolithotomy in the treatment of upper urinary tract calculus.更多还原