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双语推荐：PCNL

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目的：探讨经皮肾镜取石术治疗肾结石（PCNL）的临床疗效及出血因素。方法：回顾性分析本院收治108例肾结石患者行PCNL治疗的临床疗效和出血因素,分析PCNL治疗复杂性肾结石的临床优势,并探讨导致PCNL出血的因素。结果：108例PCNL均成功,PCNL能显著提高复杂性肾结石的临床疗效;临床分析发现影响PCNL出血因素主要有肾功能不全、结石类型及糖尿病。结论：PCNL能显著提高复杂性肾结石的临床疗效,结石类型是影响出血的主要因素,将会明显增加出血风险。
Objective:To explore the clinical efficacy and the bleeding factors of percutaneous nephrolithotomy lithotomy(PCNL).Method:108 patients with kidney stones who treated with PCNL in our hospital were analyzed retrospectively the clinical efficacy and bleeding factors,the clinical advantages of PCNL in the treatment of complex renal calculi,and to explore the factors of PCNL haemorrhage.Result:108 cases of PCNL operations were performed successfully,the PCNL surgery could significantly improve the clinical efficacy of complex renal calculi,through clinical analysis found that hemorrhagic factors of PCNL surgery mainly renal insufficiency,type of stones and diabetes.Conclusion:PCNL surgery can significantly improve the clinical efficacy of complex renal calculi,the stones type is major factor in the cause bleeding,it will significantly increase the risk of bleeding.

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目的 总结经皮肾镜碎石(percutaneous nephrolithotomy,PCNL)术后尿源性脓毒血症(urosepsis)的诊治经验.方法 回顾性分析本院5例接受PCNL治疗患者出现尿源性脓毒血症的病例资料.结果 经积极治疗后,5例患者均恢复良好,顺利出院.结论 重视尿源性脓毒血症的易感因素,PCNL术中严格遵守规程,早期发现病情,积极处理能避免PCNL严重并发症.
Objectives To summarize our experience in diagnosis and treatment of postoperative urosepsis following PCNL.Methods Data of 5 cases with postoperative urosepsis following PCNL were reviewed.Results After treatment,all 5 patients got recovery well.Conclusions Pay attention to susceptible factors of urosepsis,abide the rules strictly in PCNL procedure,early diagnosis and active treatment can prevent severe complications in PCNL.

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随着手术设备的更新以及经验的积累，经皮肾镜取石术日趋成熟，尽管也存在一些争议，但很多方面已基本达成了共识。俯卧位下X线定位穿刺，建立F18～F24通道，运用气压弹道、钬激光、超声碎石等工具综合清理结石构成经典的经皮肾镜取石术（PCNL），但微通道经皮肾镜取石术（ultra‐mini PCNL）、无管化经皮肾镜取石术（tubeless PCNL）等技术的发展也有一定的临床应用前景。不论如何，采用科学的态度，遵循基本操作原则，才能保证PCNL手术的安全有效。
ABSTRACT:With the renewal of equipment and increase of operation experience ,percutaneous nephrolithotomy (PCNL) has become more and more mature .Although there is still some controversy ,basic consensus has been accepted by many ex‐perts .Prone position ,puncture under X‐ray guidance ,F18‐24 percutaneous tract ,comprehensive cleaning stones system with pneumatic lithotripsy ,holmium laser ,and ultrasonic lithotripsy ,have been widely used in PCNL .Techniques such as ultra‐mini PCNL and tubeless PCNL are also developing .Scientific attitude and correct principles of PCNL operation can ensure the safe‐ty and efficacy of PCNL .

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目的分析研究硬膜外麻醉方法在PCNL中预防腹膜后积液的临床应用。方法随机选取我院实施PCNL的患者21例,所有患者进行身体各方面体征检查后,拟于硬膜外麻醉下行PCNL。结果术后第一天停速尿,术后7天康复出院。嘱1个月后再次入院完成手术。结论 PCNL手术的麻醉经验以更好的保证患者术中安全,值得临床推广和广泛应用。
Objective To study the epidural anesthesia method in the PCNL in prevention of peritoneal effusion after clinical application. Methods A randomly selected in our hospital 21 cases of PCNL patients, all the patients were all aspects of the body examination after epidural anesthesia, to be PCNL. Results The first postoperative day stop furosemide, after 7 days of recovery. Enjoin again after January to complete the operation admission. Conclusion PCNL operation anesthesia experience to better ensure patients safety, worthy to be popularized and applied widely.

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探讨B超引导局部麻醉经皮肾镜取石术(PCNL)在上尿路结石治疗中的安全性和价值。方法:本组60例上尿路结石患者均在B超引导局部麻醉下行PCNL治疗。结果:60例均一期穿刺造瘘成功,54例一期成功行PCNL,6例患者因脓肾改行二期PCNL,总结石清除率为95.0%。手术时间为20~120 min,平均45 min,无严重并发症。结论:B超引导局部麻醉PCNL治疗上尿路结石具有创伤小、并发症少、恢复快、结石清除率高等优点,可作为肾结石或输尿管上段结石的治疗方法。
To evaluate the safety and feasibility of minimally invasive percutaneous nephrolithotomy under the guide of B ultrasound and local anesthesia in treating upper uriny tract calculi.Method:60 patients with renal calculi or ureteral calculus who underwent PCNL were retrospectively analyzed. All 60 cases underwent PCNL with local infiltration anesthesia under the guidance of ultrasound. Result:Among 60 cases,54 cases were stone free after one stage PCNL,6 cases stone free after two stages PCNL for renal pyonephrosis. The total stone free rate was 95.0%. The operative duration was 45 min(20-120 min). No severe complications were observed. Conclusion:PCNL under the guidance of ultrasound and local infiltration anesthesia offers advantages with respect to easy operation,less invasion,less complications,high stone free rate. It is a minimally invasive way in treatment of renal and ureteral calculus.

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目的：对比经皮肾镜碎石取石术（ PCNL）和后腹腔镜输尿管切开取石术（ RLU）治疗单侧输尿管上段嵌顿性结石的疗效。方法选取2006年6月—2013年12月在厦门市第二医院行PCNL或RLU治疗单侧输尿管上段嵌顿性结石的患者153例，PCNL组83例和RLU组70例，对比两组的住院时间、手术时间、术中出血量、术后恢复时间、Ⅰ期清除率及住院费用；并记录两组手术情况。结果 PCNL组和RLU组术中出血量、Ⅰ期清除率比较，差异无统计学意义（P>0.05）；PCNL组住院时间、手术时间和术后恢复时间均较RLU组短（P<0.05）；PCNL组住院费用高于RLU组（P<0.05）。两组均无中转开腹手术。结论两种手术方式治疗单侧输尿管上段嵌顿性结石均安全有效，但PCNL具有住院时间短、手术时间短、术后恢复时间快等优点，值得临床推广。
Objective To compare the curative effect of percutaneous nephrolithotomy( PCNL)and retroperitoneal laparoscopic ureterolithotomy( RLU)in the treatment of unilateral incarcerate upper ureteric calculus. Methods 153 cases of u-nilateral incarcerate upper ureteric calculus admitted to the Second Hospital of Hospital from June 2006 to December 2013 were given PCNL or RLU treatment,with 83 cases in the PCNL group and 70 cases in the RLU group. The hospital stay,operation time,intraoperative hemorrhage,postoperative recovery time,stage Ⅰ clearance rate and hospital fees were compared between the two groups. Besides,record surgical cases of two groups. Results The intraoperative hemorrhage and stageⅠclearance rate between the PCNL group and RLU group showed no statistically significant difference(P>0. 05). The hospital stay,operation time and postoperative recovery time of the PCNL group were all shorter than those of the RLU group(P<0. 05),and the hospi-tal fee of the PCNL group

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目的：观察微通道经皮肾镜碎石术（PCNL）和标准通道 PCNL 对上尿路结石患者血流动力学和血气分析的影响。方法选取2012年1月—2013年11月重庆三峡中心医院肾结石患者200例，采用随机数字表分为微通道PCNL 组和标准通道 PCNL 组，各100例。在 PCNL 术中，微通道 PCNL 组推入 F16塑料薄鞘建立经皮肾通道；标准通道 PCNL 组推入 F24塑料薄鞘建立经皮肾通道。记录两组患者麻醉前，灌流前，灌流10、30、60、90、120 min 及术后患者平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）；手术结束时记录灌流量和手术时间；检查血常规、静脉电解质和动脉血气分析〔包括 Na ＋、Cl -、K ＋、pH、碱剩余（ BE）〕。结果微通道 PCNL 组手术时间为（102.3±19.1）min，高于标准通道 PCNL 组的（83.8±15.2）min（t ＝7.58，P ＜0.05）；微通道 PCNL 组灌流液量为（21.0±1.3）L，高于标准通道 PCNL 组的（15.6±2.0）L（t ＝22.64，P ＜0.05）。生命体征组间比较显示：两组 HR、MAP和 CVP 在不同时间点比较，差异均无统计学意义（P ＞0.05）。组内比较显示：两组 HR 不同时间点比较，差异无统计学意义（P ＞0.05）；两组灌流前 MAP 和 CVP 均低于麻醉前（P ＜0.05）；MAP 和 CVP 在灌流10 min 与灌流前比较，差异均无统计学意义（P ＞0.05）；在灌流30、60、90、120 min 及术后均高于灌流前（P ＜0.05）。动脉血气分析组间比较显示：两组 Na ＋、Cl -、K ＋、pH、BE 在不同时间点比较，差异均无统计学意义（ P ＞0.05）。组内比较显示：两组术后 Na ＋、Cl -与麻醉前比较，差异无统计学意义（P ＞0.05）。两组术后 K ＋、pH、BE 均低于麻醉前（P ＜0.01）。两组患者术后均无尿脓毒症及其他严重并发症发生。结论随着手术时间增加，灌流液的吸收对血流动力学和动脉血气分析的影响逐渐增加；对于心、肺、肾功能正常的患者，由于器官功能的代偿，微通道 PCNL 与标准通道 PCNL 引起的灌流液吸收量的差异不足以引起患者血流动力学和血气分析的不同。
Objective To explore the effects of percutaneous nephrostolithotomy(PCNL) and microchannel PCNL (mPCNL) on hemodynamics and blood gas analysis( BGA) in patients with upper urinary tract calculi. Methods From january 2012 to November 2013,200 kidney stone patients from Three Gorges Central Hospital were randomized into groups PCNL,mPCNL,100 in each. The mPCNL group were injected with F16 plastic sheath,PCNL group with F24 plastic sheath to establish percutaneous renal access. Patientsˊ mean arterial pressure( MAP),heart rate( HR),central venous pressure (CVP)before anesthesia,before perfusion,at minutes 10,30,60,90,120 of perfusion and after operations were recorded and blood routine examination, venous electrolyte, BGA including Na + , Cl - , K + , pH, base excess ( BE ) were determined. Results The surgical time of mPCNL group was(102. 3 ± 19. 1)min,higher than that of PCNL group〔(83. 8 ± 15. 2)min〕(t = 7. 58,P 0. 05),MAP,CVP lower before perfusion than before anesthesi

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探究和分析经皮肾镜碎石取石术(PCNL)与输尿管软镜钬激光碎石取石术(F-URS)治疗肾结石的临床疗效。方法:2011年1月-2014年1月收治肾结石患者98例,作为研究对象,随机分为PCNL组和F-URS组。其中PCNL组采用经皮肾镜碎石取石术治疗,F-URS组采用输尿管软镜钬激光碎石取石术治疗。对比两组患者的治疗效果。结果:PCNL组和F-URS组一期清石率分别为87.76%(43/49)和59.18%(29/49)。F-URS组的二期清石率83.33%(15/18),总清石率89.80%(44/49)。PCNL组的一期清石率和F-URS组的总清石率差异不显著,无统计学意义(P0.05)。PCNL组的手术时间明显短于F-URS组一期手术,差异有统计学意义(P0.05),但F-URS组一期和二期手术的住院时间均短于PCNL组,差异有统计学意义(P0.05)。结论:经皮肾镜碎石取石术仍是肾结石治疗的首选方式,但经皮肾镜碎石取石术(PCNL)与输尿管软镜钬激光碎石取石术(F-URS)各有优势,应根据患者的实际情况选择合适的手术方式。
Objective:To explore and analyze the clinical effect of percutaneous nephrolithotomy(PCNL) and flexible ureteroscope holmium laser lithotripsy(F-URS) in the treatment of renal calculi.Methods:98 patients with renal calculi were selected from January 2011 to January 2014.They were as the research objects.They were randomly divided into PCNL group and F-URS group. PCNL group was treated with percutaneous nephrolithotomy.F-URS group was treated with flexible ureteroscope holmium laser lithotripsy.The treatment effects of two groups were compared.Results:The first phase stone clearance rates of PCNL group and F-URS group were respectively 87.76%(43/49) and 59.18%(29/49).The second phase stone clearance rate of F-URS group was 83.33%(15/18);the total stone clearance rate was 89.80%(44/49).The first phase stone clearance rate of PCNL group and the total stone clearance rate of F-URS group had no significant difference with no statistical significance(P>0.05).The operation time of P

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目的探讨经皮肾镜取石术（PCNL）与经尿道输尿管镜碎石术（uRL）两种手术方式在输尿管上段嵌顿性结石治疗中的疗效差异。方法将120例输尿管上段嵌顿性结石患者随机分为经皮肾镜组（PCNL组）和经尿道输尿管镜组（URL组），两组各60例，分别对术后各项情况进行比较分析。结果PCNL组患者的手术时间、肉眼血尿时间及术后住院天数均长于URL组，但术后3d结石清除率及术后30d结石清除率明显高于经URL组，各项比较均有显著性差异（P〈0．05）。结论PCNL治疗输尿管上段嵌顿性结石较URL有明显的优势，虽创伤较URL大，但其结石清除率高，仍应成为输尿管上段嵌顿性结石的首选术式。
Objective To compare the clinical effect of percutaneous nephrolithotomy and transurethral ureteroscopy lithotripsy on the incaecerated upper ureteral calculi. Methods 120 patients with incaecerated upper ureteral calculi were divided randomly into percutaneous nephrolithotomy group(PCNL group) (60 cases)and transurethral ureteroscopy lithotripsy group(URL group) (60 cases),and to analyse the postoperative situation of two groups. Results The outcome of operating time、gross hematuria time and hospital stay of PCNL group were signiifcantly longer than that of URL group,but the stone free rate of PCNL group was signiifcantly superior to that of URL group at 3d and 30d after surgery(all P<0.05). Conclusion The clinical effect of PCNL is superior to that of URL on the incaecerated upper ureteral calculi, PCNL has high stone free rate though its damage is higer than URL for the moment,it is ought to considered as the ifrst choice of the incaecerated upper ureteral calculi.

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目的 总结经皮肾镜碎石(PCNL)术中冲洗液外渗并发多脏器功能障碍综合征(MODS)的诊断及治疗方法.方法 报道本院2例患者PCNL术后发生MODS诊治经过.例1术中肾盂黏膜穿孔大量冲洗液外渗,术后继发MODS,经切开引流、输蛋白利尿等方法处理后好转.例2因术中冲洗液外渗,出血性休克继发MODS,经DSA栓塞、连续性肾脏替代治疗(CRRT)、抗感染治疗后好转.结果 2例患者MODS均控制,重要脏器功能基本恢复.结论 术中干预可以防止PCNL术中冲洗液外渗MODS的发生,术后早期采取综合治疗措施可以促进重要脏器恢复.
Objectives To discuss the diagnosis and management of Multiple organ dysfunction syndrome MODS after the percutaneous nephrolithotomy(PCNL).Methods TWO cases with MODS after PCNL were reviewed.Case 1 was a man patient with staghorn calculi.After PCNL massive extravasation of irrigant fluid caused severe metabolic acidosis,and then it worsened to MODS,By sufficient drainage and using relative drugs the patient recovery quickly.Case 2 was a women patient.A massive haemorrage occurred after the PCNL.And acute hemorrhagic shock and severe sepsis happened,which brought her to MODS.Using DSA thrombosis of renal artery and continu-ous renal replacement therapy,the woman also recovered from the disease.Results The secondary MODS after PCNL was well controlled and nobody died.Conclusions The two cases gave us a lesson that we should take more attention while patients presented relative symptom.Then,the efficient intervention can be implemented.

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