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目的分析经皮肾镜取石术式中输尿管逆行插管失败的原因,探讨其处理对策。方法回顾性分析32例经皮肾镜取石术式中输尿管逆行插管失败患者的相关资料,依据肾积水的程度分别采用B超定位、经验性非影像学定位、小切口触诊+X线定位建立经皮肾通道。结果 32例患者均顺利建立经皮肾通道,无肠道损伤、胸腹膜损伤、大出血、尿外漏、肾周积液积脓、动静脉漏等并发症发生。结论经皮肾镜取石术式中输尿管逆行插管失败有主、客原因。对此类患者,中度以上肾积水患者,B超定位可建立经皮肾通道;轻度或无肾积水患者,若B超定位穿刺不成功,小切口触诊+X线定位是一种可行的方法。
Objective To analyze the causes of ureter retrograde intubation failure in percutaneous nephrolithotomy and discuss its treatment strategy. Methods Retrospective analysis of 32 cases of percutaneous nephrolithotomy ureteral retrograde intubation in patients with relevant information, according to the degree of hydronephrosis were used B-positioning, empirical non-imaging, small incision palpation + X-ray Positioning established percutaneous renal access. Results All the 32 patients were successfully established percutaneous renal access, no intestinal injury, peritoneal and peritoneal injury, bleeding, urinary leakage, peri-renal empyema, arteriovenous leakage and other complications. Conclusion Percutaneous nephrolithotomy ureter retrograde intubation failure main and passenger reasons. For such patients, moderate and severe hydronephrosis, B-percutaneous renal access can be established; mild or no hydronephrosis, if B-positioning puncture unsuccessful, small incision palpation + X-ray positioning is a Kind of feasible method.