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目的:总结提高经皮肾镜取石术(PCNL)治疗鹿角形肾结石的结石清除率的措施。方法:83例鹿角形肾结石术前行CT平扫,PCNL术时,如患侧输尿管扩张,留置两条F5输尿管导管,术中见尿液混浊或合并多发微细结石,联用负压吸引器,用气压弹道碎石器有序碎石,手术结束前必须用C臂复查结石残余情况,术后2~4d行KUB检查,统计结石清除率。结果:一期手术后56例鹿角形肾结石完全清除(67.5%,56/83),手术时间平均81min(28~142min),血红蛋白平均下降23g/L(0~54g/L),1例患者术后血红蛋白持续下降,行肾动脉造影+超选择性血管栓塞术,术后发热7例,无尿源性脓毒血症发生,无周围脏器损伤,无患者死亡。结论:术前CT平扫,术中必要时留置两条输尿管导管、联用负压吸引器,有序碎石,手术结束前C臂机检查结石残余等综合措施有助提高鹿角形肾结石PCNL术的结石清除率。
OBJECTIVE: To summarize the measures to improve stone clearance rate of anthronal kidney stones by percutaneous nephrolithotomy (PCNL). Methods: 83 cases of deer horns kidney stones before CT scan, PCNL surgery, such as ipsilateral ureteral dilatation, indwelling two F5 ureteral catheterization, see the urine opacity or multiple fine calculus surgery, combined with negative pressure suction device , Pneumatic lithotripsy with gravel, the end of the operation must be used to review the C-arm residual stones, 2 ~ 4d after the line KUB examination, statistical stone clearance. Results: Fifty-six cases of deer horned nephrolithiasis were completely eliminated (67.5%, 56/83) after operation. The mean operation time was 81min (28-142min) and the average hemoglobin was 23g / L (0-54g / L) Postoperative hemoglobin continued to decline, renal artery angiography + superselective embolization, postoperative fever in 7 cases, no urinary sepsis occurred, no peripheral organ damage, no patient died. Conclusion: Preoperative CT scan, indwelling two ureteral catheters when necessary, combined with negative pressure suction device, ordered gravel, c-arm machine before the end of surgery to check the residual stones and other comprehensive measures to help improve anthronal kidney stone PCNL Surgery stone clearance rate.