论文部分内容阅读
目的探讨VALDIVIA体位下经皮肾镜术(PCNL)治疗上尿路结石的应用价值。方法本组74例中,男47例,女27例。所有病例均常规行泌尿系B超检查,并行腹部平片(KUB)+静脉肾盂造影(IVU)检查,其中14例加用CT检查,45例为肾结石,16例为输尿管上段结石,12例为肾结石合并输尿管结石,1例为肾结石合并双侧输尿管结石及尿道结石。麻醉后在B超定位下建立皮肾穿刺通道,采用VALDIVIA体位下行PCNL。结果在所有病例中,除过2例因穿刺困难改为开放手术,1例在输尿管插管过程中损伤改开放手术外,其余71例均手术成功,无1例出现胸膜、肠管损伤等并发症。Ⅰ期取净结石38例,12例术后行Ⅱ期PCNL或配合SEWL清除干净,8例放弃后续治疗,临床无意义残留结石碎片16例,输尿管上段结石及单纯肾盂结石均Ⅰ期处理干净。结论 VALDIVIA体位下行PCNL,术中无需更换体位,是处理肾结石及部分输尿管上段结石安全、方便、实用的方法。
Objective To investigate the value of percutaneous nephrolithotomy (PCNL) in the treatment of upper urinary tract calculi under VALDIVIA position. Methods 74 cases in this group, 47 males and 27 females. All cases were routinely performed urinary tract ultrasonography and KUB + IVU. Among them, 14 cases were diagnosed by CT, 45 cases were kidney stones, 16 cases were upper ureteral calculi, and 12 cases were ureteral stones A ureteral calculi with kidney stones, one case of bilateral ureteral calculi and urethral stones with kidney stones. After anesthesia in the B-location of the establishment of renal artery puncture channel, the use of VALDIVIA position descending PCNL. Results In all the cases, the other 71 cases were successfully operated except one case of open surgery due to puncture difficulty and one case of injury during open ureteral intubation. None of the cases had complications such as pleural and intestinal injury . In stage Ⅰ, 38 cases were treated with nephrolithiasis, 12 cases were treated with stage Ⅱ PCNL or with SEWL, and 8 cases were given up for follow-up treatment. There were 16 cases of clinically meaningless residual stone fragments. The upper ureteral calculi and simple renal pelvis were all treated with stage Ⅰ. Conclusion VALDIVIA descending PCNL posture, no need to change position during surgery, is to deal with renal stones and some upper ureteral calculi safe, convenient and practical method.