仰卧位经皮进入上杯:初步经验

J.A. Zapata-Gonzalez , E.A. Ramirez-Pérez , D. López-Alvarado , J. Corona-Martinez
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引用次数: 1

摘要

背景:正确选择经皮肾镜穿刺位置是任何经皮肾镜取石手术成功的关键。理想的穿刺应在结石清除率和并发症风险方面最大限度地提高手术效果。正确选择要接触的花萼是必要的;在某些情况下,上花萼是理想的位置。目的报告我们对仰卧位患者经皮入路上极的经验。方法对经皮肾镜取石术治疗肾盂或肾盂上盏结石的患者进行回顾性、观察性、描述性研究。结果共纳入17例患者,治疗17个肾单位。17例患者(100%)均行全身麻醉。男性9例(53%),女性8例(47%),平均年龄45.8岁(18-72岁)。结石部位为右肾10例(59%),左肾7例(41%)。共有13例(76%)患者出现症状。平均体重指数为27 kg/m2(范围:20-34)。ASA分级为I级13例(76.4%),II级3例(17.6%),III级1例(5.8%)。8例(47%)患者曾接受过治疗。第一次治疗14例(82.3%)患者手术成功,第二次治疗17例(100%)患者手术成功。目前对胸膜和膈解剖的了解,实时超声经皮穿刺的使用,以及新的手术技术的发展,大大降低了胸内并发症的风险。结论患者仰卧位取上肾花萼安全、可重复性好。这种方法提供了整个肾盂局部系统的良好视野,应该保留在下花萼不是最佳选择的情况下。
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Acceso percutáneo al cáliz superior en posición supina: experiencia inicial

Background

The correct choice for the percutaneous puncture site is key to the success of any percutaneous nephrolithotomy. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free rate and minimize the risk for complications. It is necessary to correctly choose the calyx to be accessed; in certain cases the upper calyx is the ideal site.

Aims

To report our experience with the percutaneous approach to the upper pole with patients in the supine position.

Methods

A retrospective, observational, descriptive study was carried out on patients with stones in the renal pelvis or upper calyx treated through percutaneous nephrolithotomy.

Results

A total of 17 patients were included in the study, and 17 kidney units were treated. All 17 patients (100%) underwent general anesthesia. Nine (53%) of the patients were men and 8 (47%) were women, with a mean age of 45.8 years (range: 18-72). Stone site was the right kidney in 10 (59%) patients and the left in 7 (41%). A total of 13 (76%) patients were symptomatic. The mean body mass index was 27 kg/m2 (range: 20-34). ASA classification was I in 13 (76.4%) patients, II in 3 (17.6%) patients, and III in one (5.8%) patient. Eight (47%) patients underwent previous treatments. Procedure success or stone-free rate was achieved in 14 (82.3%) patients with the first treatment and in 17 (100%) with the second treatment.

Discussion

Current knowledge of the pleural and diaphragmatic anatomy, the use of real time ultrasound for percutaneous puncture, and the development of new surgical techniques have considerably reduced the risk for intrathoracic complications.

Conclusions

Access to the upper calyx with the patient in the supine position is safe and reproducible. This approach provides excellent vision of the entire pyelocaliceal system and should be reserved for cases in which the lower calyx is not the best option.

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来源期刊
Revista mexicana de urologia
Revista mexicana de urologia Medicine-Urology
CiteScore
0.20
自引率
0.00%
发文量
49
期刊介绍: Revista Mexicana de Urología (RMU) [Mexican Journal of Urology] (ISSN: 0185-4542 / ISSN electronic: 2007-4085) is bimonthly publication that disseminates research by academicians and professionals of the international medical community interested in urological subjects, in the format of original articles, clinical cases, review articles brief communications and letters to the editor. Owing to its nature, it is publication with international scope that disseminates contributions in Spanish and English that are rigorously reviewed by peers under the double blind modality. Neither journalistic documents nor those that lack rigorous medical or scientific support are suitable for publication.
期刊最新文献
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