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目的探讨两点定位穿刺技术在微创经皮肾镜(MPCNL)术中的应用价值。方法 2005年9月～2012年2月,对肾结石及输尿管上段结石,采用两点定位穿刺技术完成606例MPCNL,结石包括鹿角状结石、多发性肾结石、ESWL治疗失败、孤立肾结石、开放取石手术后复发、输尿管上段结石。参照术前CT和IVP确定皮肤穿刺点(第一点)、穿刺角度及要穿刺的肾盏,在X线指导下嘱病人吸气时或呼气时使第一点与要穿刺的肾盏成垂直线,此时目标肾盏的位置作为第二穿刺点(要记好是吸气还是呼气时的位置),然后不再需要X线的指导,调整好角度进行目标肾盏穿刺。应用李逊肾镜联合气压弹道或U-100激光碎石。结果 550例1～2次穿刺成功,46例3～6次穿刺成功,总的成功率98.3%(596/606),10例再次X线定位小切口分离至肾周在左手示指指导下穿刺成功。2例穿刺扩张进入胸腔,其中1例放置胸腔闭式引流管,另1例及时发现并处理未放置导管;1例术后第1天大出血(经选择性肾动脉栓塞止血)。结石取净率95.7%(580/606),26例残余结石,均≤0.5 cm。结论两点定位穿刺技术应用于经皮肾镜术中安全有效,医生和病人对X线的接触少,值得推广。
Objective To investigate the value of two-point positioning puncture in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods From September 2005 to February 2012, 606 cases of MPCNL were treated with two-point targeted puncture in the upper and upper ureteral calculi. Stones included antlers, multiple nephrolithiasis, ESWL failure, isolated kidney stones, and open Recurrence of stone surgery, upper ureteral stones. According to preoperative CT and IVP to determine the skin puncture point (first point), the puncture angle and the calyx to be punctured, under the guidance of the X-ray instruct patients to breathe or exhale when the first point and the calyx to be punctured Vertical line, then the location of the target calyx as the second puncture point (to remember good is the position of breathing or exhalation), and then no longer need X-ray guidance, adjust the angle of the target renal caliper. Application Li Xun kidney mirror combined with pneumatic ballistic or U-100 laser lithotripsy. Results One hundred and two successful punctures were performed in 550 cases, 46 cases were successfully punctured 3 to 6 times, with a total success rate of 98.3% (596/606). Ten cases were re-X-ray small incision to the perirenal area. . Two patients underwent puncture and dilatation into the thoracic cavity. One patient had a closed thoracic drainage tube and the other one patient had not been placed in time. One patient had hemorrhage on the first day after operation (selective renal artery embolization to stop bleeding). The stone removal rate was 95.7% (580/606), 26 residual stones were ≤0.5 cm. Conclusions The two-point positioning and puncture technique is safe and effective in percutaneous nephrolithotomy. It is worth to be popularized that doctors and patients have little contact with X-ray.