percutaneous nephrolithotomy

The success rate of percutaneous nephrolithotomy is high, and the treatment of kidney stones can reach 98.3%. It is suitable for stones with large kidney stones and other treatment methods (especially extracorporeal shock wave lithotripsy). Treatment of diseases: kidney stones Indication Percutaneous nephrolithotomy is suitable for stones with large kidney stones, cast stones, inferior collateral stones, stones with distal urinary tract obstruction, and other treatments (especially extracorporeal shock wave lithotripsy). The most suitable for percutaneous nephrolithotomy is a healthy, thin, single stone with a diameter greater than 2 cm, a stone in a mildly stagnant renal pelvis or an enlarged renal pelvis. The treatment of large cast stones with percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy is also very satisfactory. Contraindications Contraindications include: generalized hemorrhagic tendency, ischemic heart disease, severe respiratory insufficiency, obesity, waist and kidney distance of more than 20cm, inconvenient to establish percutaneous renal access, high kidney with splenomegaly or hepatomegaly, Renal tuberculosis, uncorrected diabetes, high blood pressure, acute intrarenal or perirenal infection, severe kyphosis and other patients can not be treated with percutaneous nephrolithotomy. Patients with isolated kidney should not undergo percutaneous nephrolithotomy. Preoperative preparation 1. Do a good job of related systemic examinations, such as clotting time, platelet count, liver and kidney function, electrocardiogram, etc., to know the true state of the body in advance to facilitate symptomatic treatment. 2. Understand the urinary system, and do not rush to crush the stone without knowing the urinary system. The following checks must be made before the gravel. (1) Abdominal plain film (KUB): More than 95% of urinary calculi are positive stones, so for patients suspected of having urinary calculi, KUB examination should be the first choice. The advantage is that you can fully understand the location and size of the stone. The location, number and density, and most importantly, can not miss the middle and lower ureteral stones. (2) B-ultrasound: mainly for the diagnosis of negative stones, has a good display effect on intra-renal stones and intra-renal water, the detection rate of ureteral stones, especially the middle and lower ureteral stones is extremely low, and it is difficult to judge the composition of stones. (3) urography: including intravenous urography (IVP) and retrograde urography, intravenous urography commonly used, can accurately locate the stone, to determine whether it is a diverticulum stone or renal stenosis is very helpful Retrograde urography is the application of poor renal urinary function and kidney development. The purpose is to clearly understand whether the urinary tract is obstructed after the failure of intravenous urography. (4) Kidney chart examination: For patients with allergic stones, renal diagram should be used to understand renal function. (5) Trinity joint examination: I specialize in the combination of B-ultrasound, abdominal plain film (KUB) and abdominal electroporation to monitor the whole urinary tract stones, dynamic electro-optics and static plain film with B-ultrasound exploration, the advantages of the three, the big In most cases, it is not worse than the results of angiography and CT scans. Surgical procedure A percutaneous nephrolithotomy was used to open a 1 cm skin incision in the lower back, and a thin puncture needle was used to directly enter the kidney from the incision, placed into the nephroscope, and the stone was crushed using an ultrasonic ballistic lithotripter or holmium laser. 1 Ultrasonic lithotripsy uses the piezoelectric effect of the ultrasonic transducer to convert electrical energy into acoustic energy, which is then transmitted to the tip along a rigid probe. When the tip of the probe contacts the stone, the high frequency vibration of the ultrasonic wave can grind the stone. Small pieces into powder or shattered stones. 2 Liquid-electric crushed stone is the instantaneous release of high-voltage electrical energy stored in a capacitor through an electrode placed in water, which converts electrical energy into force energy and directly breaks the stone. The impact of liquid electricity is very strong, and the effect of crushing stone is good. 3 Pneumatic ballistic lithotripsy is the principle of simulating the air hammer. The energy generated by the compressed gas pushes the bullet body inside the handle, and transfers the energy to the probe in the ballistics. The tip of the probe repeatedly collides with the stone to crush the stone. 4 In recent years, lasers for urinary tract debris have been newly developed holmirm lasers. The holmium laser is a pulsed laser generated by a rare element , with a wavelength of 2140 nm, which is located just in the absorption range of water, and the peak power can reach up to kilowatts in an instant. The holmium laser can emit laser light through a quartz optical fiber having a diameter of 320 to 550 um and a low water content. It is crushed by the endoscope directly against the stone, which is the preferred method of internal lithotripsy for most urinary stones. Compared with pneumatic lithotripsy and other internal lithotripters, the efficiency and safety of holmium laser lithotripsy is significantly improved. Compared with traditional lasers, holmium laser has obvious advantages. In addition to being used for gravel, holmium laser also has the function of cutting vaporized soft tissue and solidifying hemostasis. For long-term, inflammatory reactions, stones that have formed a package can first vaporize the wrapped soft tissue and then crush the stone. The holmium laser can pulverize various constituent stones including cystine stones and calcium oxalate monohydrate. 5 electronic kinetic energy gravel, electronic kinetic energy lithotripter consists of the main unit, handle and foot switch 3 parts. It works in much the same way as a pneumatic ballistic lithotripter, which breaks stones by initiating a similar impact motion of a small metal probe. The difference is that the electron kinetic energy gravel is formed by the magnetic energy generated by the magnetic core in the handle to form a high-speed short-distance linear motion, which rebounds directly and directly hits the metal probe, generates a steep kinetic energy shock wave, and is transmitted to the stone through the probe. , crush the stone. complication The wound is mild. Less bleeding, low complications, its main complications are intraoperative and postoperative bleeding, perforation of renal pelvis, adjacent organ injury, infection, perirenal urinary and so on.