侧卧位微创经皮肾镜取石术治疗输尿管上段结石.doc
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1、DOC格式论文,方便您的复制修改删减侧卧位微创经皮肾镜取石术治疗输尿管上段结石(作者:_单位: _邮编: _) 作者:梁坚,李文雄,李峻,罗力,王森,王忠,曹明欣【摘要】 目的 探讨侧卧位微创经皮肾镜取石术治疗输尿管上段结石的临床应用价值。方法 回顾性分析我院2007年1月12月采用侧卧位微创经皮肾镜取石术治疗输尿管上段结石25例的临床资料,均为单侧结石,合并肾结石6例,KUB测得结石最大经1.02.7 cm。结果 本组平均手术时间45 min(2590 min),平均住院8 d (512 d)。22例单通道一期手术,3例因术中发现肾积脓,留置造瘘管后改二期手术。术前血红蛋白(11425)g/
2、L,一期手术后13 d检查血红蛋白(112.523.5)g/L。术后高热2例。总结石排净率100%。无大出血和其他严重并发症发生。结论 侧卧位对患者比较舒适,对外科医生的术中操作和麻醉师的术中观察都比较方便,值得临床推广使用。 【关键词】 输尿管上段结石;经皮肾穿刺取石术;侧卧位Abstract: Objective To explore the clinical value of minimally invasive percutaneous nephrolithotomy (mPCNL) in lateral decubitus position in the management of
3、upper ureteral calculi. Methods 25 patients were analyzed retrospectively, who suffered from upper ureteral calculi and were treated with minimally invasive percutaneous nephrolithotomy in lateral decubitus position between January 2007 and December 2007. These patients included 18 men and 7 women,
4、with an average age of 38yearsold (23 to 65 years). All patients ureteral calculi were unilateral and 6 cases were combined with kidney calculi. The diameter measured by KUB ranged from 1.0 cm to 2.7 cm. Results The mean operative duration was 45 min (ranging from 25 to 90 min) and the average hospi
5、tal stay lasting for 8 days (ranging from 5 to 12 days). 22 cases were treated with only one percutaneous access tract in a single session and 3 cases were only placed stoma tube and underwent a secondlook procedure because of pyonephrosis. The average preoperative hemoglobin was (11425)g/L. On the
6、first to third postoperative day, hemoglobin was reexamined, with an average of (112.523.5)g/L. 2 cases had high fever postoperatively. The stonefree rate was 100%. Excessive hemorrhage and other severe complications did not occur. Conclusions The lateral decubitus position, the most familiar to uro
7、logists, is also an ideal position for mPCNl in the management of upper ureteral calculi. It adds ease and comfort to the patient, anesthesiologist, and surgeon.Key words:upper ureteral calculi; percutaneous nephrolithotomy; lateral decubitus position输尿管上段大结石和嵌顿包裹性结石是体外冲击波碎石术(ESWL)和输尿管镜较难处理的结石,应首选微创
8、经皮肾镜取石术治疗。由于传统的经皮肾镜手术体位多采用俯卧位进行手术,病人比较辛苦,也给麻醉观察带来不便。我科近10年在熟练掌握俯卧位手术技巧的基础上,进行了手术改良,于2007年1月至2007年12月采用侧卧位微创经皮肾镜取石术治疗输尿管上段结石25例也取得了很好的疗效。现就本组病例的临床治疗进行分析和总结。1 资料与方法1.1 一般资料 2007年1月12月,我院共采用侧卧位微创经皮肾镜碎石术治疗输尿管上段结石25例,其中男18例,女7例,年龄2365岁,平均38岁。均为单侧结石,合并肾结石6例,KUB测得输尿管结石最大经1.02.7 cm。超声波(B超)示23例肾脏有明显中度以上积水,集合
9、系统分离25.2 cm。静脉尿路造影(IVU)有8例患侧肾显影不清。合并高血压2例,糖尿病1例,肾功不全(血肌酐165324 mol/L)2例,曾行开放手术后输尿管结石复发4例,术前发热患肾积脓4例,其中3例术前行穿刺置管引流及抗生素治疗,体温正常57 d,尿色转清后再进行手术。1.2 治疗方法 25例输尿管上段结石病人均采用连续硬膜外麻醉,8例首先取截石位,于输尿管镜下向患侧输尿管内插入斑马导丝,退出输尿管镜,沿导丝向患侧输尿管内置入F6号输尿管导管至输尿管上段结石下方,退出导丝,留置输尿管导管。取传统肾结石开放手术侧卧体位,头低脚低、摇高腰桥。使肾脏与皮肤距离变得更浅,更易于穿刺。2例轻度
10、肾积水的患者采用B超穿刺探头定位,23例采用盲穿成功,刺点一般在第12肋下或第11肋间,范围在肩胛线和腋后线之间。选择好最佳穿刺角度(与水平夹角2545)、穿刺点位置用尖刀切开皮肤0.5 cm的小切口,以18G穿刺针经该切口穿入积水的肾盂肾盏,当穿刺针芯拔除后有明显尿液或注入的生理盐水流出时,可以确认穿刺针已进入肾的集合系统。置入斑马导丝,退出穿刺针鞘。沿导丝以筋膜扩张器由F8起一直扩张至F16-18号,置入F16peelaway鞘,沿鞘置入F9.8输尿管肾镜观察,找到输尿管肾盂连接处,向输尿管上段入镜,看清结石后使用气压弹道碎石,冲洗、钳夹将碎石排出。8例已插输尿管导管者,经导管注水加快结石
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- 侧卧 位微创经皮肾镜取石术 治疗 输尿管 上段 结石
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