柱状气囊肾造瘘管在经皮肾镜碎石术中的止血作用
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摘要
目的探讨柱状气囊肾造瘘管在经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)穿刺通道止血中的临床价值。方法 2016年1月～2017年1月285例PCNL术中应用柱状气囊肾造瘘管,用镜体测量放置柱状气囊肾造瘘管的长度,按测量的长度将柱状气囊肾造瘘管置入Peel-away鞘内,使柱状气囊正好压迫在肾实质瘘口部位,自气囊中充适量气体,使气囊充分压迫到肾实质瘘口上,体表用丝线缝合固定造瘘管。结果 285例自造瘘管和留置尿管中引流尿液颜色正常,术后均无早期或迟发出血,复查B超,均无肾内、肾周血肿出现,术后5～7 d拔除肾造瘘管,8 d出院。术后随访6个月,无出血和结石复发。结论柱状气囊肾造瘘管在PCNL术中止血疗效确切,对出血的防治有重要的临床价值。
Objective To investigate clinical effects of columnar balloon renal fistula on hemostasis at puncture access in percutaneous nephrolithotomy(PCNL).Methods A retrospective analysis was conducted on 285 patients who underwent columnar balloon renal fistula during the PCNL from January 2016 to January 2017.The length of columnar balloon nephritic fistula was measured by endoscope.The fistula tube was placed in Peel-away sheath according to the length of measurement.The columnar balloon was compressed exactly at the site of renal parenchymal fistula.The balloon was filled with appropriate gas,so that the balloon was fully compressed to the renal parenchymal fistula.The fistula tube was fixed by suture of silk thread on the body surface.Results In all the 285 cases,the color of drainage urine from fistula and indwelling catheter was normal.No case had early or delayed bleeding postoperatively.Re-examinations of B ultrasonography found no renal clot was observed.No intrarenal or perirenal hematoma occurred.The renal fistula tube was removed in 5-7 days and all the patients were discharged from hospital in 8 days after surgery.Follow-ups for 6 months found no bleeding or stone recurrence.Conclusion Columnar balloon nephritic fistula has definite effect on hemostasis and important clinical value of preventing bleeding in PCNL.
Objective To investigate clinical effects of columnar balloon renal fistula on hemostasis at puncture access in percutaneous nephrolithotomy(PCNL).Methods A retrospective analysis was conducted on 285 patients who underwent columnar balloon renal fistula during the PCNL from January 2016 to January 2017.The length of columnar balloon nephritic fistula was measured by endoscope.The fistula tube was placed in Peel-away sheath according to the length of measurement.The columnar balloon was compressed exactly at the site of renal parenchymal fistula.The balloon was filled with appropriate gas,so that the balloon was fully compressed to the renal parenchymal fistula.The fistula tube was fixed by suture of silk thread on the body surface.Results In all the 285 cases,the color of drainage urine from fistula and indwelling catheter was normal.No case had early or delayed bleeding postoperatively.Re-examinations of B ultrasonography found no renal clot was observed.No intrarenal or perirenal hematoma occurred.The renal fistula tube was removed in 5-7 days and all the patients were discharged from hospital in 8 days after surgery.Follow-ups for 6 months found no bleeding or stone recurrence.Conclusion Columnar balloon nephritic fistula has definite effect on hemostasis and important clinical value of preventing bleeding in PCNL.
引文
1李刚,孙浩,周留正,等.经皮肾镜钬激光碎石术治疗肾脏结石96例分析.中国微创外科杂志,2013,13(11):1018-1030.
2姜福金,马松,王洪兵,等.微创经皮肾镜取石术出血并发症防治.中国内镜杂志,2008,14(12):1287-1290.
3杨庆亚,黄晓波,许清泉,等.经皮肾镜取石术后常规夹闭肾造瘘管的必要性研究.中国微创外科杂志,2017,17(2):137-140.
4 Evans LA,Morey AF.Hemostatic agents and tissue glues in urologic injuries and wound healing.Urol Clin North Am,2006,33(1):1-12.
5 Uribe CA,Eichel L,Khonsari S,et al.What happens to hemostatic agents in contact with urine?An in vitro study.J Endourol,2005,19(3):312-317.
6 Millard WW,Jellison FC,Tenggardjaja C,et al.Hemostatic sandwich to control percutaneous nephrolithotomy tract bleeding.JEndourol,2010,24(9):1415-1419.
7何永忠,刘建河,曾国华,等.微创经皮肾镜取石后迟发出血原因及介入治疗.中华泌尿外科杂志,2006,27(6):371-373.
8袁源湖,刘佛林,邹晓峰,等.超选择性肾动脉栓塞治疗微创经皮肾镜取石术后出血(附5例报告).江西医药,2007,42(11):973-975.
2姜福金,马松,王洪兵,等.微创经皮肾镜取石术出血并发症防治.中国内镜杂志,2008,14(12):1287-1290.
3杨庆亚,黄晓波,许清泉,等.经皮肾镜取石术后常规夹闭肾造瘘管的必要性研究.中国微创外科杂志,2017,17(2):137-140.
4 Evans LA,Morey AF.Hemostatic agents and tissue glues in urologic injuries and wound healing.Urol Clin North Am,2006,33(1):1-12.
5 Uribe CA,Eichel L,Khonsari S,et al.What happens to hemostatic agents in contact with urine?An in vitro study.J Endourol,2005,19(3):312-317.
6 Millard WW,Jellison FC,Tenggardjaja C,et al.Hemostatic sandwich to control percutaneous nephrolithotomy tract bleeding.JEndourol,2010,24(9):1415-1419.
7何永忠,刘建河,曾国华,等.微创经皮肾镜取石后迟发出血原因及介入治疗.中华泌尿外科杂志,2006,27(6):371-373.
8袁源湖,刘佛林,邹晓峰,等.超选择性肾动脉栓塞治疗微创经皮肾镜取石术后出血(附5例报告).江西医药,2007,42(11):973-975.