Minimally invasive percutaneous pneumatic lithotri

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Minimally invasive percutaneous pneumatic lithotripsy and care coordination

Key words minimally invasive percutaneous With the development of urological endoscopy, urinary stones from the traditional open surgery minimally invasive endoscopic treatment of steering. Minimally invasive percutaneous pneumatic lithotripsy of skin from the back to the renal collecting system, to establish channels for the treatment of renal, ureteral calculi of the method, which has a trauma, less bleeding, fewer complications, ureteroscopy and swing Turn the large range, can reach most of the renal pelvis and calyx, even using narrow neck into the caliceal caliceal stone clearance rate is higher, etc. [1]. 1 to 6 months of 2006 in our hospital using minimally invasive percutaneous pneumatic lithotripsy treatment of renal, ureteral calculi in 14 cases, satisfactory effect, now and intraoperative surgical care with the following report. Chinese papers League finishing. 1 clinical data total of 14 patients in this group of patients, 8 males and 6 females, aged 28 to 65 years old , average 44.6 years old. One double kidney stones in 4 cases, 4 cases of ureteral calculi merger, conversion to open surgery in 1 case. 2 preoperative preparation 2.1 were prepared for patients with preoperative routine visits, in understanding the basis of medical history and condition and comfort to encourage patients, patients answered questions patiently, be explained The surgical procedures and techniques of the difficulties that may arise and treatment so that patients are fully prepared with the surgery . 2.2 equipment items ready 2.2.1 ureteroscopy and stone removal devices clamp equipment, pneumatic lithotripsy machine and handle, 1.0 mm and 1.6 mm stone needle, puncture the expansion device (18G needle ,8-16F fascial dilator and supporting Peel-away sheath, 1 ~ 2 Zebra guide wire), infusion pumps and television camera display system, B-machines. 2.2.2 F5 prepared sterile double bottle) , brain protective film with the incision, 20 cm × 120 cm Case 4 (Protection of camera, optical fiber, lithotripter handle and B-probe), laying prone position lithotomy position, and 1 set of each dressing, 14 # or 16 # T tube, the simple suture equipment, a large number of sterile saline. 2.2.3 Item position and prone position lithotomy position 1 set of each item. 2.3 equipment sterilization ureteroscopy, stone extraction forceps, needle and puncture pneumatic lithotripsy expansion equipment, infusion pumps and water immersion with 2% alkaline glutaraldehyde disinfection of more than 30 min before use with sterile physiological saline to rinse the residual glutaraldehyde, including the lumen. 3 general anesthesia with continuous epidural anesthesia are mostly, but also according to patient needs general anesthesia by inhalation. 4 surgical procedures and with the 4.1 earnestly implement the surgery Placed in the operating room equipment should meet the requirements and habits of the surgeon and the full use of space, the general home TV camera display system, B-machine in the contralateral surgeon, infusion pumps in patients who left, pneumatic lithotripsy machine in the patients who right. 4.2 establishment of intravenous access, anesthesia to help assist the surgeon wearing surgical gown, gloves, remove the necessary equipment, fully washed with sterile saline, and yaw in a sterile instrument table. 4.3 surgical procedures in accordance with (ipsilateral ureteroscopic retrograde ureteral catheterization, biopsy, to establish percutaneous renal access, gravel and stone), and gradually with the doctors to operate. 4.3.1 retrograde ( 1) first placed the lithotomy position, routine disinfection of shop towels, connect the camera, fiber guided beam, perfusion tubes. Under direct vision through the ureteroscope, F5 or F6 home ureteral catheter to the renal pelvis (for intraocular surgery for pelvic effusion catheter as a sign of renal pelvis and ureter, but also to prevent patients falling into the inlet pipe in the gravel, but also in surgery retrograde injection of saline in the pressure to speed up passage of renal stone out from the skin [2]). (2) ipsilateral ureter to be successful retrograde intubation, indwelling catheter, ureteral catheter and the catheter will be fixed properly with the prone position after the change (ipsilateral lumbar Xiadian a small pillow, so that patients with lower back uplift, is conducive to puncture [3]), routine disinfection of shop towels, paste, cut protective film brain surgery (intraoperative fluid collection, preventing wet drapes can protect the surgical area from pollution and protect patients from infusion liquid cooling stimuli effect), then set the bucket end of fluid bags. Connect the camera, fiber guided beam,[link widoczny dla zalogowanych], infusion tube, pneumatic lithotripsy machine handle and so on. 4.3.2 biopsy channel and the establishment of percutaneous pyelography under the XB-pictures and intraoperative positioning in posterior axillary line and the twelfth rib or cross-border crossing point at 2 cm below the 1 ~ 1.5 cm skin incision and a small incision. In the B-guided puncture the renal collecting system puncture after the success of the guide wire into the zebra, and dilator along the guide wire with a gradually expanding to Fr14 ~ Fr16, Peel-away sheath to remain as working channels. 4.3.3 ureteroscopic lithotripsy, stone the preoperative and intraoperative X-ray photographs in the B -position, determine the stone's location, size, ureteroscopy along the guide wire by the Peel-away sheath can reach the renal collecting system, rotation and swinging ureteroscopy to find stones. Peel-away sheath to adjust the depth and angle and align the stone , slightly fixed stones, lithotripsy stone corner or edge of the needle from the beginning, the use of intermittent batter method of rubble, the broken end so easily scattered in the other kidney stone lamp. Of broken stones, ureteral stone with a slightly larger clamp removed; small stone, the use of retrograde catheter and infusion pump pressure washing, from the Peel-away plastic sheath thin wash out stone to accelerate the speed and improve the stone taken net rate.