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目的探讨斜卧位经超声引导行微通道经皮肾穿刺取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)治疗嵌顿性输尿管上段结石的安全性和可行性。方法术前患侧输尿管逆行插管,患侧向上45°斜卧位,肩部及臀部用软垫支撑。经超声引导进行穿刺、扩张建立F16～F18经皮肾通道,采用输尿管镜钬激光碎石取石。结果 61例手术均获成功,无穿刺失败和中转开放手术者。术中出血量20～150 ml,平均75 ml。手术时间35～105 min,平均60 mim。一期结石清除率93.4%(57/61)。61例随访1～6个月,平均3个月,B超或KUB检查无结石残留。结论斜卧位经超声引导下行MPCNL,患者体位舒适,超声引导可提高穿刺成功率,有效避免并发症,一期结石清除率高。
Objective To investigate the safety and feasibility of ultrasonography guided minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of incarcerated ureteral calculi. [Methods] Preoperative ipsilateral ureter retrograde intubation, suffering from lateral 45 ° oblique position, shoulders and buttocks with cushion support. Guided by ultrasound guided puncture, expansion established F16 ~ F18 percutaneous renal access, ureteroscopic holmium laser lithotripsy stone. Results 61 cases of surgery were successful, no puncture failure and transit open surgery. Intraoperative bleeding 20 ~ 150 ml, an average of 75 ml. The operative time was 35 to 105 minutes with an average of 60 mim. A stone clearance rate of 93.4% (57/61). 61 cases were followed up for 1 to 6 months, an average of 3 months, B-or KUB no stone residue. Conclusions The oblique position is guided by MPCNL. The patient position is comfortable and ultrasound guidance can improve the success rate of puncturing, effectively avoiding the complication and the rate of primary stone removal is high.