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目的:探讨超声在经皮肾镜取石术中的价值与操作技巧。方法:2010年6月～2011年9月对452例肾结石、输尿管上段结石患者行经皮肾镜取石术,术中均采用超声定位穿刺建立经皮肾通道、指导寻找结石、帮助术中决策等。结果:全部患者均成功建立皮肾通道,其中1针成功421例,2针成功31例;定位穿刺耗时5～14min,平均8min;无大出血及周围脏器损伤等严重并发症发生;单通道取石396例,双通道49例,三通道7例;术中镜体可见视野内无结石后再次超声扫查发现结石残留37例,按超声提示位置再次寻找或建立通道取石,结石清除率92.0%。术后随访2～12个月,无迟发性出血、感染等并发症。结论:超声定位建立经皮肾通道具有定位准确、成功率高的优点,术中可指导寻找剩余结石,并帮助术中决定是否结束手术、再次寻找结石或建立通道,但需掌握一定的操作技巧。
Objective: To investigate the value and technique of ultrasound in percutaneous nephrolithotomy. Methods: From June 2010 to September 2011, 452 patients with renal calculi and ureteral calculi underwent percutaneous nephrolithotomy. All the patients underwent percutaneous nephrostomy through ultrasound-guided percutaneous puncture to find the stones and help to make decisions during operation . Results: All the patients were successfully established skin and renal access, including 421 cases of successful needle 1 and 2 cases of successful 31 cases; positioning puncture took 5 ~ 14min, an average of 8min; no major bleeding and other serious complications of organ damage; single-channel 396 cases of double-channel, 49 cases of double-channel, 7 cases of three channels; 37 cases of residual stones were seen by ultrasound scan after operation without any stones in the scope of operation; 92.0% . Postoperative follow-up 2 to 12 months, no delayed bleeding, infection and other complications. Conclusion: Ultrasound-guided percutaneous nephrostomy has the advantage of accurate positioning and high success rate. During the operation, it can guide to find the remaining stones and help intraoperative decide whether to finish the operation, find the stones again or establish the passage again, but need to master certain operation skills .