部分無管化經(jīng)皮腎鏡取石術的臨床療效分析
發(fā)布時間:2018-06-23 來源: 幽默笑話 點擊:
【摘要】 目的:探討無管化經(jīng)皮腎鏡取石術(PCNL)治療腎及輸尿管上段結石的安全性和有效性。方法:回顧性分析2014年3月-2017年2月本院采用部分無管化PCNL聯(lián)合超聲氣壓彈道碎石治療腎及輸尿管上段結石患者317例的臨床資料。觀察患者結石清除率、腎周血腫發(fā)生率、腎周積液發(fā)生率、尿外滲發(fā)生率、高熱(>38.5 ℃)發(fā)生率、出血及輸血情況、術后24 h的疼痛情況(VAS評分)。結果:患者均Ⅰ期成功建立20F或22F經(jīng)皮腎通道,無穿刺失敗及中轉開放手術者,未發(fā)生感染性休克,無患者因嚴重大出血需介入及切腎治療。結石清除率95.90%(304/317),術后Hb平均下降(7.57±3.03)g/L,術后嚴重血尿持續(xù)(2.24±0.74)d,術后VAS評分(3.12±0.32)分,術后高熱發(fā)生率5.36%(17/317),術后輸血率為0.32%(1/317),腎周血腫發(fā)生率1.58%(5/317),腎周積液發(fā)生率2.21%(7/317),尿外滲發(fā)生率2.21%(7/317)。結論:在掌握手術適應證的前提下,無管化PCNL治療腎及輸尿管上段結石是安全有效的。
【關鍵詞】 經(jīng)皮腎鏡取石術; 輸尿管支架; 腎造瘺管
Analysis of the Clinical Efficacy of Tubeless Percutaneous Nephrolithotomy/SONG Wenjun,LIU Qing,ZHANG Qian,et al.//Medical Innovation of China,2018,15(07):100-104
【Abstract】 Objective:To investigate the clinical efficacy and safety of tubeless percutaneous nephrolithotomy(PCNL) intreatment of renal and upper ureteral calculi.Method:The clinical data of 317 patients
with renal and upper ureteral calculi treated with tubeless PCNL combined with ultrasonic pneumatic lithotripsy from March 2014 to February 2017 were retrospectively analyzed.The stone clearance rate,the incidence of perirenal hematoma and effusion,the incidence of extravasation of urine,the incidence of high heat(>38.5 ℃),bleeding and blood transfusion,and 24 h postoperative pain(VAS score) of patients were observed.Result:All patients were successfully established 20F or 22F percutaneous renal access successfully during stage Ⅰ,no patients puncture failure and transfer to open surgery,no septic shock occurred,no patient needed interventional and nephrectomy for severe massive hemorrhage.The stone clearance rate was 95.90%(304/317),postoperativedecrease of Hb average(7.57±3.03) g/L,postoperative sustained severe hematuria was(2.24±0.74) d,postoperative VAS score was(3.12±0.32) points,postoperative incidence of high heat was 5.36%(17/317),postoperative blood transfusion rate was 0.32%(1/317),the incidence of perirenal hematoma was 1.58%(5/317),the incidence of perirenal effusion was 2.21%(7/317),the rate of extravasation of urine was 2.21%(7/317).Conclusion:Under the condition of mastering the indication of operation,tubeless PCNL is safe and effective intreatment of renal and upper ureteral calculi.
【Key words】 Percutaneous nephrolithotomy; Ureteral stent; Nephrostomy tube
First-author’s address:Shenyang Red Cross Hospital,Shenyang 110013,China
doi:10.3969/j.issn.1674-4985.2018.07.028
經(jīng)皮腎鏡取石術(PCNL)這種手術方式由于對人體的傷害相對較小,并發(fā)癥的發(fā)生率較低,治療效果顯著等原因,在上泌尿系結石的治療中被廣泛應用[1]。通常情況下,PCNL手術后均會將一根腎造瘺管留置在腎盂內,引流腎臟內的尿液,利用腎造瘺管的管壁對腎實質內血管進行壓迫止血,促進通道愈合成竇道二次手術等作用[2]。但在長期的臨床觀察中發(fā)現(xiàn),腎造瘺管不但會引起患者術后疼痛不適,還可引起術后腎臟出血,即患者術后2~3 d,尿色轉清后再次出現(xiàn)嚴重血尿,拔除腎造瘺管后尿色恢復正常。本院嘗試2014年3月-2017年2月在317例患者的PCNL手術后不再留置腎造瘺管,僅留置輸尿管支架管,臨床療效滿意,現(xiàn)報道如下。
相關熱詞搜索:療效 臨床 分析 無管化經(jīng)皮腎鏡取石術
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