Clinical analysis of one-stage ultrasound guided transabdominal PCNL for the treatment of stones in pelvic ectopic kidney
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摘要: 目的:探讨运用超声引导下经腹腔途径穿刺扩张建立皮肾通道的经皮肾镜取石术(PCNL)一期治疗盆腔异位肾合并肾结石的疗效及安全性。方法:回顾性分析我院2016年6月~2019年1月收治的5例盆腔异位肾肾结石的患者运用超声引导下经腹腔途径PCNL治疗的临床资料。全麻仰卧位,在超声引导下用超声探头推开肠管进行经腹途径穿刺扩张建立皮肾通道,并对手术效果及并发症等进行分析。结果:所有病例均一期成功建立皮肾通道并处理结石。平均手术时间为74.6 min。其中1例盆腔异位肾术后残石0.6 cm,其他4例均完全清除结石。无输血、腹腔脏器损伤和尿源性脓毒症的发生。结论:盆腔异位肾的特殊结构导致其泌尿系统与周围脏器的解剖关系严重异常,手术风险和难度高。该手术属于非常规区域PCNL,需术前充分了解腹腔脏器与异位肾的解剖关系,熟练运用超声探头推开腹腔肠管建立皮肾通道完成清石,手术效率高,术后并发症较少,操作可行。Abstract: Objective: To investigate the efficacy and safety of one-stage ultrasound-guided transabdominal percutaneous nephrolithotomy(PCNL) for the treatment of stones in pelvic ectopic kidney. Method: From June 2016 to January 2019, five cases with stones in pelvic ectopic kidney under ultrasound-guided transabdominal PCNL for the treatment of stones were selected in study. Patients received the operation in supine position under general anesthesia. The intestine was shoved by ultrasound probe under the guidance of ultrasound and the working access was established. The operation effect and complications were analyzed statistically. Result: All cases were treated with one-stage PCNL. The average operative time was 74.6 min. Among them, a 0.6 cm residual stone in one case was left over. The stones of other four cases were completely removed. No transfusion, abdominal organ injury or urinary sepsis occurred.Conclusion: Pelvic ectopic kidney leads to serious abnormality of the anatomic relation between the urinary system and the surrounding organs. The risk and difficulty of the operation are higher. This operation is a kind of abnormal puncture in PCNL. It can be carried out under the premise of fully understanding the anatomical position of the abdominal organs, while using ultrasonic probe proficiently to push abdominal bowel fully to set up channel and complete stone removal. The operation is efficient and feasible with few postoperative complications.
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