经皮肾穿刺通道的选择

目的探讨经皮肾穿刺取石术穿刺通道的选择碎石、取石成功率的影响。方法根据结石的位置、大小、形态选择确定目标肾盏、体表穿刺点、穿刺角度和深度,用穿刺针经皮肾穿刺至肾盏,并逐级扩张建立工作通道。结果肾穿刺69例穿刺均成功,单通道63例,2通道4例,3通道2例。穿刺无大出血及周围脏器损伤,术后发现16例患者结石大于0.5 cm的残石,接受2期经皮肾镜或体外震波碎石治疗,残石率23.2%。其中1例出现高灌注综合征,穿刺通道丢失1例,肾盂穿孔3例,但没有出现其他严重并发症。结论经皮肾穿刺取石术中准确合理选择穿刺通道是手术成功的关键,能够减少出血、降低残石率。

Choice of Percutaneous Access of Puncture Percutaneous Nephrolithotripsy for Treatment of Renal Stone

Objective To evaluate the effect of stone clearance of management of renal stone by percutaneous nephrolithotrip- sy （PCNL）by choice of percutaneous access. Methods According to the site, size and shape of renal stone determine target calyx, skin puncture site, angle and depth of puncture, percutaneous access from skin to calyx Was constructed by percutaneous puncture nee- dle and was gradually expand. Results The percutaneous kidney access was successfully established in whole the patients, single channel was performed on 63 cases two channel on 4 cases three channel on cases. Stones were cleared in 53 out of 69 cases（76.8.1%） during immediate phase lithotripsy, residual stone fragment was found in 16 cases （ 〉 0.5cm） who received second PCNL or adjuvant extracorporeal shock wave lithotripsy. 1 case had perfusate absorbing sydrome, 1 case 10st the tract of puncture, 3 case had renal pel- vic perforation, but no other severe complications occured was select of accurately and reasonable is key of success o It during nephrolithotripsy. Conclusion It that percutaneous renal access has adventages of diminished residual stone and hemorrhage.