无管化经皮肾镜取石术48例临床分析

医学研究与教育 ›› 2013, Vol. 30 ›› Issue (2): 40-43.

无管化经皮肾镜取石术48例临床分析

刘晋阳¹,赵春利²,张伟²

1.河北大学,河北保定 071002
2.河北大学附属医院泌尿科,河北保定 071000

收稿日期:2016-10-09 修回日期:2016-10-09 出版日期:2013-04-25 发布日期:2013-04-25

Clinical Analysis of Tubeless Percutaneous Nephrolithotomy (48 cases)

Received:2016-10-09 Revised:2016-10-09 Online:2013-04-25 Published:2013-04-25

摘要/Abstract

摘要： 目的探讨行无管化经皮肾镜取石术的最初经验、疗效、安全性及其优点.方法2009年4月至2012年12月对肾和输尿管上段结石患者行经皮肾镜手术的被列入研究组计划,当手术结束时确认无结石残留,无严重的出血,无明显集合系统的损伤即可不放置肾造瘘管和(或)输尿管支架管.鹿角形结石、结石的大小、仰卧位穿刺、俯卧位穿刺、肾脏解剖结构异常、孤立肾、手术时间为非影响因素.结果共施行无管化的经皮肾镜取石术48例,其中包括5例完全无管化的经皮肾镜取石术.患者术后恢复快,费用相对较低,48例患者均在短期内出院.其中1例双侧同时部分无管的患者出现术后高热,更换头孢三代抗生素后体温恢复正常.1例完全无管的出现术后剧烈的疼痛,给予对症处理后痊愈出院.结论无管化经皮肾镜取石术治疗肾和输尿管上段结石是一种经济、安全、有效的方法,是否行无管化决定于手术结束时术者的判断.

关键词: 无管化, 经皮肾镜取石术, 肾结石

Abstract: Objectives To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection and evaluate the safety and feasibility of tubeless percutaneous nephrolithotomy. Methods All consecutive PCNL performed during 2009-2012 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless. PCNL over time. Results Of 600 PCNL performed during the study period 48 (71%) were tubeless. Including 5 cases of the procedure was totally tubeless percutaneous nephrolithotomy. The postoperative recovery time and relatively cost was low, 48 patients were discharged in the short term. 1 case of bilateral and tubeless percutaneous nephrolithotomy appears postoperative high fever. The temperature returned to normal after replace cephalosporins antibiotics of three generations. One patient with totally tubeless percutaneous nephrolithotomy had severe postoperative pain and discharge after give received alimta. conclusion Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without preoperative contraindications. They are easily accommodated by experienced endourologists and provide real advantages.

Key words: tubeless, percutaneous nephrolithotomy, kidney calculi

中图分类号:

刘晋阳,赵春利,张伟. 无管化经皮肾镜取石术48例临床分析[J]. 医学研究与教育, 2013, 30(2): 40-43.

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