摘要
目的探讨在输尿管硬镜处理“不能窥见全貌”输尿管上段结石钬激光碎石中,采用间断性膨肺技术提高碎石成功率的安全性和有效性。方法回顾性分析2016年3月至2017年10月输尿管硬镜术中采用间断性膨肺技术处理“不能窥见全貌”的输尿管上段结石患者56例,术中麻醉师间断性膨肺,改变和短时间稳定输尿管结石位置,保证输尿管镜视野,进行钬激光碎石取石术。术后1、3个月复查泌尿系腹部平片或CT尿路造影了解结石残余等情况,评价临床疗效。结果48例1次碎石成功;5例输尿管硬镜碎石过程中部分结石逃逸至肾内,改用输尿管软镜碎石;3例由于术前结石负荷太大需要二期碎石,其中2例体外冲击波碎石、1例体外冲击波碎石+输尿管镜下碎石取石术。术后1个月结石清除率94.6%(53/56),术后3个月结石清除率为100%(56/56)。术中及术后无输尿管撕脱穿孔、大出血、感染性休克、气胸等严重并发症。结论在全麻气管插管麻醉下,采取输尿管硬镜处理“不能窥见全貌”输尿管上段结石术中,通过间断性膨肺,可以有效改变结石位置,进行安全、有效地碎石,拓展了输尿管硬镜处理输尿管上段结石的适应证。
Objective To analyze the effectiveness and safety of intermittent lung inflation combined with rigid ureteroscopy in the treatment of upper ureteral stones that were not fully visible.Methods The clinical and imaging data of 56 patients with upper ureteral stone undergoing rigid ureteroscopic lithotripsy combined with intermittent lung inflation in Zhejiang Quhua Hospital from March 2016 to October 2017 were retrospectively analyzed.Intermittentt lung inflation was used to change and stabilize the position of ureteral calculi during the operation,so as to ensure the visual field of ureteroscopy.Holmium laser lithotripsy was performed to remove the stones.Urinary tract abdominal plain X-ray or CT urography was performed 1 and 3 months after the operation to evaluate the residual stones and the clinical efficacy.Results Stones were successfully removed after a single attempt in 48 patients.In 5 patients,stones escaped into the kidney during ureteroscopic lithotripsy,and thus flexible ureteroscopy were performed.In 3 patients,a second session of auxiliary procedure was required,among whom 2 patients received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy+ureteroscopic lithotripsy.The stone-free rates 1 and 3 months after surgery were 94.6%(53/56)and 100%(56/56),respectively.No severe complication such as ureter perforation,gross hematuria,septic shock,or pneumothorax occurred during and after surgery.Conclusions Intermittent lung inflation in tracheal intubation under general anesthesia in patients with proximal ureteral stones that can not be fully visible during rigid ureteroscopic lithotripsy was feasible and reliable.It can effectively change the location of stones and thus enable safe and effective lithotripy.It expands the indications of rigid ureteroscopy for treating upper ureteral stones.
作者
王进峰
郭建华
郑卫国
邝乾华
瞿巍巍
祝宏斌
黄振昭
舒文云
黄培
吴建华
WANG Jinfeng;GUO Jianhua;ZHENG Weiguo;KUANG Qianhua;QU Weiwei;ZHU Hongbin;HUANG Zhenzhao;SHU Wenyun;HUANG Pei;WU Jianhua(Department of Urology,Zhejiang Quhua Hospital,Quzhou,Zhejiang 324004,China;Department of Urology,No 9 People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200011,China;Department of Anesthesiology,Zhejiang Quhua Hospital,Quzhou,Zhejiang 324004,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2019年第6期793-798,共6页
Acta Academiae Medicinae Sinicae
基金
浙江325卫生高层次人才计划资助(浙卫发2013-245)~~
关键词
间断性膨肺
输尿管硬镜
输尿管上段结石
intermittent lung inflation
rigid ureteroscopy
upper ureteral stone
