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目的探讨导丝在经皮肾镜手术中提高一期结石清除率的临床疗效。方法 30例复杂性肾结石患者均经导丝引导下来提高结石清除率。首先建立一穿刺通道,用超声及气压弹道将视野内结石击碎并冲出体外。如超声检查示有肾盏结石残留,应保留原穿刺通道,超声引导下经有残余结石的肾盏进行穿刺,穿刺成功后将导丝置入肾盂,超声证实导丝位于肾盂内,经第1个穿刺通道进镜寻找导丝,沿导丝寻找肾盏内结石。如因角度太小,沿导丝无法探及结石,则利用导丝建立第2穿刺通道进行碎石。结果 2例因角度太小行两通道碎石,余28例均一通道碎石成功,结石一次性完全清除,2例患者术后第6天出现血尿,无胸膜损伤、尿瘘、感染及大出血等并发症出现。结论经皮肾镜碎石术中导丝的引导作用可显著提高一期结石清除率,尤其对复杂性肾结石患者,可减少多通道碎石引起大出血、感染及尿瘘等并发症的发生。
Objective To investigate the clinical efficacy of guide wire in percutaneous nephrolithotomy to improve the rate of primary stone removal. Methods Thirty patients with complicated nephrolithiasis were guided by guide wire to improve the stone clearance rate. The first to establish a puncture channel, with ultrasound and pressure ballistic vision crushed stone and out of the body. Such as ultrasound showed renal calyceous stones should remain the original puncture channel, under the guidance of ultrasound calculus of residual calculus after puncture, the successful insertion of the guide wire into the renal pelvis, ultrasound confirmed that the guide wire in the renal pelvis, the first 1 A puncture channel into the mirror to find the guide wire, along the guide wire to find calculus within the calyx. If the angle is too small, along the guide wire can not explore the stones, the use of guide wire to establish the second puncture channel gravel. Results Two cases of lithotripsy due to too small angle and two channels of lithotripsy resulted in the successful removal of 28 cases of uniform channel gravel. The stones were cleared completely in one operation. The hematuria, non-pleural injury, urinary fistula, infection and hemorrhage occurred on the 6th postoperative day in 2 patients Symptoms appear. Conclusions The guiding effect of guide wire in percutaneous nephrolithotomy can significantly improve the rate of primary stone removal. Especially for patients with complex renal calculus, complications such as massive bleeding, infection and urinary fistula can be reduced by multi-channel lithotripsy.