[1]苏志勇① 张珩 田野** 罗光恒.日间微通道经皮肾镜碎石取石术30例[J].中国微创外科杂志,2021,01(4):336-339.
　Su Zhiyong,Zhang Heng*,Tian Ye*,et al.Clinical Review of 30 Cases of Ambulatory Surgery of Minimally Invasive Percutaneous Nephrolithotomy[J].Chinese Journal of Minimally Invasive Surgery,2021,01(4):336-339.
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日间微通道经皮肾镜碎石取石术30例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年4期
页码:
336-339
栏目:
临床研究
出版日期:
2021-04-25

文章信息/Info

Title:
Clinical Review of 30 Cases of Ambulatory Surgery of Minimally Invasive Percutaneous Nephrolithotomy
作者:
苏志勇① 张珩 田野** 罗光恒
（贵州省人民医院泌尿外科，贵阳550002)
Author(s):
Su Zhiyong;  Zhang Heng*;  Tian Ye*;  et al.
*Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, China
关键词:
日间手术; 微通道经皮肾镜碎石取石术; 尿路结石
Keywords:
Ambulatory surgery; Minimally invasive percutaneous nephrolithotomy; Urinary calculi
文献标志码:
A
摘要:
目的探讨微通道经皮肾镜碎石取石（minimally invasive percutaneous nephrolithotomy，mPCNL）日间手术的可行性和安全性。方法我院2017年8月~2019年8月选择30例上尿路结石在日间手术模式下行mPCNL，B超引导下经皮肾穿刺和通道扩张，建立F16通道完成mPCNL。术后严密监测各项生命体征，复查血常规、肝肾功能、电解质、尿路平片及拔除尿管后进行评估，符合出院标准的患者准予出院。结果均建立单通道顺利完成mPCNL，其中29例24 h内出院，1例因术后出现发热，延迟出院。无管化率93.3%（28/30）,一期清石率96.7%（29/30）。2例术后3~5 d运动后出现迟发性出血，保守治疗后血尿消失。2例诉腰胀不适，症状较轻无特殊处理。所有患者术后1个月复查KUB证实结石清除后于门诊成功拔除双J管。30例随访3个月，未见结石复发、尿外渗、大出血及尿源性脓毒血症等并发症，且无手术相关再入院。结论对于单发且直径<3 cm上尿路结石，通过充分术前准备以及严格的术后管理，mPCNL采用日间手术模式是安全可行的。
Abstract:
ObjectiveTo explore the feasibility and safety of ambulatory surgery of minimally invasive percutaneous nephrolithotomy (mPCNL).MethodsFrom August 2017 to August 2019, 30 selected patients with upper urinary tract calculi received ambulatory surgery of mPCNL in our hospital. All the patients were examined preoperatively in the outpatient clinic and admitted before strict evaluation. The mPCNL was performed with the F16 tract established under ultrasound guidance. Vital signs were closely monitored after the operation. Routine blood examination, liver and kidney function tests, electrolyte levels and KUB were rechecked and urine tubes were removed for evaluation. Patients meeting discharge criteria were allowed to discharge.ResultsAll the operations of mPCNL were successfully completed. Among them, 29 cases were discharged within 24 hours, and 1 case was delayed due to postoperative fever. The tubeless rate was 93.3% (28/30), and the calculifree rate of stage Ⅰ was 96.7% (29/30). Two patients showed delayed bleeding after exercise within 3 to 5 days postoperatively, and hematuria disappeared after conservative treatment. Two patients complained of waist distension and discomfort and received no special treatment. One month after surgery, the double J tubes were successfully removed after the removal of calculi confirmed by KUB. During 3 months’ followup period, no complication such as recurrence of calculi, extravasation of urine, massive bleeding or urinary sepsis occurred, and no cases of operationrelated readmission were found.ConclusionFor selected patients with single upper urinary calculi less than 3 cm in diameter, ambulatory surgery of mPCNL is safe and feasible when perioperative management is carefully conducted.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金(81860141)；贵州省卫计委基金(gzwjkj2017-1-032) **通讯作者，Email：584500474@qq.com ① （贵州医科大学附属医院泌尿外科，贵阳550004）
更新日期/Last Update: 2021-06-30