NO.1 case introduction
Patient Yumou, a gender woman is 68 years old
The main complaint was admitted to the hospital for 'intermittent pain in the right waist for more than June, worsening for 5 days'.
Diagnosis of 1 kidney stones (right), 2 urinary infection
Getting Story color Doppler ultrasound reminder: There are several strong echoes in the right kidney collection system. The larger ones are about 2.5cmx1.0.cm; CT see the right kidney, the middle and lower stones, the CT value is 1100HU
Preoperative abnormal test results were 580.00/ul, 10.00/ul at the routine red blood cells.
Pre -operation CT image
The difficulty of surgery is located in the middle and lower cups. The stones have a large load and a length of 2.5cm. If the ureteral soft mirror crushing is adopted, the surgery time will be longer, and it is difficult to clean the stones at one time. The stones are taken through the peculiar nephoscopy. Because the renal pelvis has no accumulated water, the difficulty of puncture increases, and the probability of bleeding increases.
NO.2 Surgical process
Surgery time 2023 09: 55--11: 20
Surgical record
① After the anesthesia is successful, the patient takes the stone, and the conventional skin in the surgery area disinfection and a sterile towel.
② Insert the video fiber into a disposable visual ureteral sheath (Youkang), insert the bladder under the urethral look, observe the normal bladder mucosa, the bilateral ureter opening is symmetrical and non -deformed, and the ureteral ureter is set under the guidance of the zebra. Enter the ureteroscopic sheath to the lower edge of the pelvic pelvic ureteral connection. Patients take the prone position and rise in the abdomen. The conventional skin in the surgery area disinfects and is sterilized.
③ Use Needle-PERC to visualize the needle-shaped renal mirror under the B-ultrasound positioning under the axillary rear line near the rib to the right kidney, and the needle renal mirror is confirmed to enter the middle cup. After the mirror is successful, there are multiple stones in the lower and lower cups of the kidneys, yellow yellow, and the maximum diameter is about 2.5cm. The needle -shaped nephron fiber channel is placed in a laser fiber, and the energy is 1.0J × 20Hz. The water injection channel is injected with water, and the stones are crushed. After the gravel is completed, the zebra is placed through the ureteroscopy sheath, and the double J tubes are placed, the ureteral sheath sheath is exited, the ureter is left, and the surgery is over.
④ Anesthesia is satisfied, the surgery is smooth, no side damage, and no obvious bleeding during the operation.
Surgical picture
NO.3 postoperative situation
The patient's postoperative life signs are stable, without pain, and small trauma. The hospital was discharged on the second day after the operation.
Postoperative pictures
The abdominal flat film showed 24 hours after surgery, and the stones were excreted by about 95%. See the figure below after surgery:
NO.4 Surgery Highlights
Using Needle-Perc visual acupuncture gravel and ureteroscopic sheath with the following advantages: 1. Needle-Perc visual across nephosphoscopy process visible, can achieve precise puncture and small damage, no need Expansion channels; 2. Remove the ureteroscopic sheath is conducive to the discharge of water injected into the kidneys in the process of gravel, thereby reducing the pressure in the kidney, and at the same time, the rock powder is flushed out through the water flow, and the rock takes the rock, solving the simply use of Needle to use Needle -PERC visual acupuncture -like renal mirrors can only be limited to gravel and cannot take stones; even if the stones are large load, this method can be used for crushing stone. This case has a maximum long diameter of 2.5cm, and KUB is 24 hours after surgery. The flat film shows 95%of the stones has been discharged, achieving a good treatment effect.
