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目的探讨B超引导下建立F24标准皮肾取石通道出现困难时的应对措施。方法复杂肾结石9例。其中肾结石无积水者8例,重度肾积水者1例。B超引导下建立取石通道均出现困难。4例无肾积水者经输尿管导管注入美兰注射液,再以输尿管镜观察,寻找集合系统;2例无肾积水者改X线C型臂监视下,调整扩张器深度,配合输尿管镜观察;重度肾积水者以输尿管镜沿导丝寻找集合系统;另2例改小切口手指引导下直接穿刺肾脏并扩张。结果 7例患者均通过相应方法找到集合系统,并进一步扩张成功建立F24经皮肾取石通道;2例小切口手指引导下成功建立F24经肾取石通道。结论无积水及重度积水肾结石较难建立取石通道。经输尿管导管注入美兰、改X线C型臂透视下操作或输尿管镜沿导丝寻找,多可进入集合系统,成功建立经皮肾取石通道。小切口手指引导下建立经肾取石通道简单易行,可作为避免转开放手术的最后补救措施。
Objective To investigate the countermeasures for establishing the F24 standard renal access tunnel under the guidance of ultrasound. 9 cases of complicated kidney stones. There were 8 cases of kidney stones without water and 1 case of severe hydronephrosis. B-guided pathways are difficult to establish under the guidance. 4 cases without hydronephrosis by ureteral catheter injection of Meilan injection, and ureteroscopy to look for a collection system; 2 cases of hydronephrosis to X-ray C-arm monitoring, adjust the dilator depth, combined with ureteroscopy Observation; severe hydronephrosis with ureteroscopy along the guide wire to find the collection system; the other two cases to change the small incision finger directly punctured the kidneys and dilated. Results All the 7 patients found the collection system by the corresponding methods and further expanded the successful establishment of F24 percutaneous nephrolithotomy channel. Two small incision finger-guided successful establishment of F24 by renal stone access. Conclusion No hydronephrosis and severe hydronephrosis are more difficult to establish stone access. The ureteral catheter into Meilan, X-ray to X-ray operation or ureteroscopy along the guide wire to find, and more can enter the collection system, the successful establishment of percutaneous nephrolithotomy access. Under the guidance of a small incision finger to establish a simple access via the renal stone access, can be used as a last resort to avoid turning open surgery remediation measures.