标题：超声定位在经皮肾镜取石术中的应用

      作者：赵华才，贾莉，陈远刚，谢明琪，尹强
    (中国十九冶集团有限公司职工医院泌尿外科，四川 攀枝花 617023)

      卷次： 2016年27卷6期

      【摘要】 目的 探讨超声定位在经皮肾镜取石术中的应用效果。方法 选取我院2014年1月至2015年3月
期间行经皮肾穿刺钬激光碎石术患者215例。所有患者采用超声定位引导下行经皮肾穿刺，建立通道，术中协助处
理残余结石。结果 所有患者均成功建立经皮肾通道，行钬激光碎石清石，其中1针穿刺成功185例，2针穿刺成功
21例，多针穿刺成功 9例。一步扩张法建立通道后置入内窥镜行钬激光碎石术，一期结石清除率为 75.3%(162/
215)，二期结石清除率为92.1%(198/215)。术后出现2例继发性出血，经行超选择性肾动脉栓塞后治愈。术后住院
时间6~9 d，平均7.5 d。随访全部病例2~12个月，腰部疼痛、血尿等症状均消失，无结石复发。结论 超声定位引
导下经皮肾穿刺具有使用灵活方便、定位准确、成功率高的优点。其可避开穿刺路径上的脏器及帮助术中寻找结
石，但超声较X线直观性差，需要掌握一定的操作技巧才可灵活使用。

      【关键词】 超声；经皮肾镜；定位；取石

      【中图分类号】 R699.2 【文献标识码】 A 【文章编号】 1003—6350（2016）06—0987—04


Application of ultrasound localization in percutaneous nephrolithotomy by one-step dilation method.
ZHAO
Hua-cai, JIA Li, CHEN Yuan-gang, XIE Ming-qi, YIN Qiang. Department of Urology, the Worker's Hospital of China 19th
Metallurgical Corporration, Panzhihua 617023, Sichuan, CHINA

【Abstract】 Objective To investigate the application effect of ultrasound localization in percutaneous nephroli-
thotomy. Methods A retrospective analysis was conducted on 215 cases of percutaneous holmium laser nephrolithoto-
my in our hospital from January 2014 to March 2015. The channel was established after percutaneous nephrolithotomy
under the guidance of ultrasound localization. The residual stones were removed during the operation. Results The per-
cutaneous renal channel was successfully established in all patients. The holmium laser lithotripsy was conducted.
Among the 215 patients, 185 underwent successful puncture by one needle, 21 underwent successful puncture by 2 nee-
dles, and 9 underwent successful puncture by multiple needles. After the channel was established by one-step dilation
method, the endoscope was placed for holmium laser lithotripsy. The stone clearance rates in first and second stages
were 75.3% (162/215) and 92.1% (198/215). Two cases of secondary hemorrhage occurred after operation and were
cured after selective renal artery embolization. The postoperative hospital stay was 6~9 d (7.5 d in average). All the pa-
tients were followed up for 2~12 months. The waist pain, hematuria and other symptoms disappeared, and no stone recur-
rence was observed. Conclusion Percutaneous nephrolithotomy under the guidance of ultrasound localization has the
advantages of flexible and convenient use, accurate positioning and high success rate. It can avoid organs on puncture
path and seek stone, but the intuition of ultrasound is poorer than that of X-ray. Therefore, ultrasound should be flexibly
used by mastering a certain operation skills.

      【Key words】 Ultrasound; Percutaneous nephrolithotomy; Localization; Lithotomy
·临床经验·
6350.2016.06.044