GPS导航超声系统引导下超细经皮肾镜取石术治疗无积水肾下盏结石的临床应用

Clinical application of real-time ultrasonography-guided ultra-mini percutaneous nephrolithotomy using SonixGPS navigation in treatment of lower caliceal calculi without hydronephrosis

摘要:

摘要：目的??探讨GPS导航超声系统引导超细经皮肾镜取石术（UMP）治疗无积水肾下盏结石的临床疗效及安全性。方法?回顾性分析2017年1月-2017年9月该院23例采用GPS引导UMP治疗无积水肾下盏患者的临床资料。其中，单发结石17例，多发结石6例。结石大小14.0～25.0?mm，平均（18.3± 3.6）mm，结石CT值880～1?610?Hu，平均（1?253.6±182.8）Hu。俯卧位建立“人工肾积水”后在GPS导航引导下16G穿刺针穿刺入目标肾盏，退出针芯见灌注液流出后，将F3超细肾镜直接沿穿刺针鞘进入肾集合系统，进一步确认穿刺针鞘头端在目标肾盏位置，并找到肾盏颈口，调整穿刺针鞘方向及深度使其头端靠近盏颈口或进入肾盂内。退出超细肾镜，置入斑马导丝，扩张通道至F14后置入F13外鞘，使用超细经皮肾镜进行碎石取石。结果?23例均单通道经下盏穿刺行UMP。定位穿刺时间2～8?min，平均（4.2±1.6）min，一次穿刺成功率为100.00%。手术时间30～65?min，平均（42.3±7.6）min；术后住院天数2～5?d，平均（2.6± 0.5）d；血红蛋白下降0～27?g/L，平均（11.2±5.1）g/L。术后止痛药的使用率为0。术后第1或2天复查腹平片（KUB）评估结石清除率为95.65%（22/23）。所有患者围手术期未出现发热、严重出血、集合系统穿孔、通道丢失和胸膜损伤等并发症。结论?GPS导航超声系统结合UMP治疗无积水肾下盏结石安全、有效，结石清除率高，术后恢复快，值得临床推广应用。

Abstract:

Abstract: Objective?To investigate the clinical efficacy and safety of real-time ultrasonography-guided ultra-mini percutaneous nephrolithotomy (UMP) using SonixGPS navigation in treatment of lower caliceal calculi without hydronephrosis.?Methods?From January 2017 to September 2017, 23 cases of lower caliceal calculi without hydronephrosis were treated with UMP under real-time ultrasonography-guided by SonixGPS navigation. 17 cases among them were single stone, while the other 6 cases were multiple renal stones. The mean stone size is (18.3?±?3.6)?mm in diameter, CT value (1253.6?±?182.8)?Hu.?Results?Single-access UMP punctured via lower caliceal was performed in all the 23 cases successfully. The mean puncture time was (4.2?±?1.6)?min; mean operation time was (42.3?±?7.6)?min; mean postoperative hospital stay was (2.6?±?0.5)?d; mean hemoglobin drop was (11.2?±?5.1)?g/L. No major complications were recorded and no analgesic consumption perioperatively. The stone clearance rate was 95.65% (22/23).?Conclusion?Real-time ultrasonography-guided UMP using SonixGPS navigation for the treatment of lower caliceal calculi without hydronephrosis is safe and effective, with high stone free rate and easy recovery, which can be popularized in clinical practice.