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目的:探讨肾下盏入路经皮肾镜双J管放置困难的原因及技术改进。方法:改良放置双J管方法为先通过逆行放置的输尿管导管放置0.038英寸斑马导丝至肾盂,用抓钳拉到工作鞘外;拔除输尿管导管,沿斑马导丝顺行放置F_8引导导管至输尿管内;然后拔除斑马导丝,通过引导导管顺行放置斑马导丝至膀胱;最后拔除引导导管,沿斑马导丝顺行放置双J管。结果:628例肾下盏入路经皮肾镜手术中168例患者需要改良方法放置双J管。检测25例行改良方法放置双J管者和57例常规方法放置双J管者肾下盏肾盂夹角(LPIA);前者的LPIA明显小于后者(56.0±12.58)∶(77.4±11.40)(P<0.0001)。结论:对下盏入路经皮肾镜放置双J管困难的患者,改良方法简单、省时、微创并且成功率高。当LPIA小于60°,应该尝试改良放置双J管方法。
Objective: To investigate the causes and technical improvement of the difficulty of placement of percutaneous nephrolithotyphous double J tube in the treatment of lower calyx. Methods: To improve the placement of double J-tube method for the first place by retrograde placement of ureteral catheters 0.038-inch zebra guide wire to the renal pelvis, with the grasping forceps to work outside the sheath; removal of the ureteral catheter, along the zebra guidewire placed F_8 guide catheter to the ureter ; And then remove the zebra guide wire, zebra guide wire placed through the guide catheter to the bladder; the final removal of the guide catheter, placed along the zebra guide wire along the double J tube. Results: Of the 628 patients who underwent percutaneous nephrolithotomy, 62 patients needed improved J-tube placement. Twenty-five patients underwent double J tube placement and 57 patients underwent conventional JI tube placement. The LPIA of the former was significantly less than that of the latter (56.0 ± 12.58), (77.4 ± 11.40) ( P <0.0001). Conclusion: It is simple, time-saving, minimally invasive and high success rate in patients with difficult percutaneous nephrolithotomy placed in double J tube. When LPIA is less than 60 °, one should try to improve the method of placing double J tube.