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目的:探讨经皮肾镜取石术(PCNL)治疗鹿角形肾结石术中穿刺点、穿刺径路的合理选择及扩张、通道建立的技巧。方法:总结在X线定位下PCNL治疗36例鹿角形肾结石患者的经皮肾通道建立与治疗效果。结果:Ⅰ期手术穿刺、通道建立、成功碎石率100%;Ⅰ～Ⅲ期结石完全清除率83.33%;单通道26例(72.22%),双通道7例(19.44%),三通道3例(8.33%);无大出血、感染休克等严重并发症发生。结论:PCNL治疗鹿角形肾结石的第一个穿刺点首选中后组盏,径路应与目标盏长径相吻合;带鞘扩张时扩张器应进入集合系统内约2cm,退出扩张器直接完成通道建立;Ⅰ期建立单通道处理肾盂、中组肾盏结石为主,Ⅱ期先经Ⅰ期通道处理上下盏残留结石,慎重建立第二、三条经皮肾通道。
Objective: To explore the technique of percutaneous nephrolithotomy (PCNL) in the treatment of stab-laden kidney stones, reasonable choice of puncture path and expansion and channel establishment. Methods: The establishment and treatment of percutaneous renal access in 36 patients with deer-angle nephrolithiasis under PCNL under X-ray localization were summarized. Results: Surgical puncture was performed in stage Ⅰ, and the success rate of gravel was 100%. The complete removal rate of stage Ⅰ ~ Ⅲ stones was 83.33%. There were 26 cases (72.22%) of single-channel, 7 cases of double-channel (8.33%); no serious bleeding, infection and other serious complications occurred. Conclusion: PCNL treatment of deer horn-shaped kidney stones in the first puncture point after the first group of light, the path should be consistent with the target long diameter; dilatation with dilatation sheath should enter the collection system about 2cm, exit the dilator directly to complete the channel The establishment of single-channel treatment of renal pelvis, the group of calyceal stones based on the first phase of the first phase after the treatment of residual light upper and lower calculus, careful to establish the second and the three percutaneous renal access.