Bai F D, Wu H F, Wen J M, Zhang N, Zheng Y C, Chen J M, Du C J
Department of Urology, the Second Affiliated of Zhejiang University School of Medicine, Hangzhou 310009, China.
Zhonghua Yi Xue Za Zhi. 2018 Feb 6;98(6):454-456. doi: 10.3760/cma.j.iss.0376-2491.2018.06.012.
To evaluate the clinical application and effect of preseting Double-J ureteric stent in percutaneous nephrolithotripsy. 74 cases of renal calculi treated with PCNL in our hospital during June 2014 to February 2017 were retrospectively analyzed. Of 74 cases, 54 was male, 20 was female. All cases were aged 27 to 78, the mean age was (49.5±12.3) years old. The diameter of the stone was 20 to 59 mm, and the mean diameter was of (29.4±4.3) mm.Our Surgical methods was first putingFr6 double J tube in abnormal ureteral in advance in lithotomy position, then indwellingthree-way Foley catheter and clipping drainage port, perfusingirrigation port with 3 000 ml saline from 60-80 cm height.Perfusingsaline through irrigation port in prone position, we produce artificial hydronephrosis, then indwelling channel Fr20 through B ultrasound guided percutaneous nephrostomy, and removing renal calculi using holmium laser lithotripsy. All patients were successfully completed percutaneous nephrostomy and indwell Fr20 channel, mean channel set up time (8.0 ±2.0) min, mean operation time (79±46) min, mean decline of hemoglobin (17.0±4.0) g/L, mean serum creatinine increased(3.1±1.1) μmol/L, one-stage stone-free rates 81.1%, complication rate 8.1% (1 case injured pleura and suffered from pneumothorax, 1 case suffered from massive hemorrhage of renal arteriovenous fistula after operation, 4 cases suffered postoperative fever). Advance in percutaneous nephrolithotripsy indwelling double J tube is a safe and feasible method, which is advantageous to the percutaneous renal puncture and the establishment of channels, and can avoid the blindness of along the line of indwelling double J.
评估预置双J输尿管支架在经皮肾镜碎石术中的临床应用及效果。回顾性分析2014年6月至2017年2月在我院接受经皮肾镜取石术（PCNL）治疗的74例肾结石患者。74例中，男性54例，女性20例。所有患者年龄27至78岁，平均年龄（49.5±12.3）岁。结石直径20至59mm，平均直径（29.4±4.3）mm。我们的手术方法是先在截石位将Fr6双J管预先置入异常输尿管，然后留置三腔Foley导尿管并夹闭引流口，从60 - 80cm高度向灌注冲洗口注入3000ml生理盐水。在俯卧位通过灌注冲洗口注入生理盐水，制造人工肾积水，然后在B超引导下经皮肾穿刺留置Fr20通道，使用钬激光碎石术清除肾结石。所有患者均成功完成经皮肾穿刺并留置Fr20通道，平均通道建立时间（8.0±2.0）分钟，平均手术时间（79±46）分钟，平均血红蛋白下降（17.0±4.0）g/L，平均血清肌酐升高（3.1±1.1）μmol/L，一期结石清除率81.1%，并发症发生率8.1%（1例损伤胸膜并发气胸，1例术后发生肾动静脉瘘大出血，4例术后发热）。经皮肾镜碎石术中预先留置双J管是一种安全可行的方法，有利于经皮肾穿刺及通道建立，可避免双J管沿输尿管走行的盲目性。
