基层医院行微创经皮肾输尿管镜取石术治疗上尿路结石体会

【文献标识码】A

【文章编号】1008-7044(2015)01-0036-03

DOI: 10．14126/j．cnki．1008－7044．2015．01．017

【作者单位】安徽省怀远县第二人民医院外二科，233400

【作者简介】赵广锋(1977－)，男，安徽怀远县人，副主任医师，大学。

Application of minimally invasive percutaneous nephrolithotomy in treatment of upper urinary stones in local hospi-

tals

ZHAO Guang-Feng，WANG Xin，ZHANG Wei．(Department of Surgery，The Second People＇s Hospital of Huaiyuan County，

Bengbu，Anhui 233400，China)

【Abstract】Objective To study the clinical effect of minimally invasive percutaneous nephrolithotomy(MPCNL)with holmium laser in treatment of upper urinary stones in grass-roots hospitals．Methods　Clinical data of 288 cases treated with MPCNL were summarized．Results The stone-free rate was 95% in patients with kidney stones and 100% for those with upper urinary stones．No case was complicated with injury of pleura and aerothorax．No abdominal organ injury occurred．No case underwent renal hemorrhage nephrectomy．Urinary tract infection after operation was seen in 8 patients．5 patients complicated with delayed hemorrhage after operation were successfully treated with blood transfusion and super selective renal artery embolization．1 case died．Conclusion Treatment of upper urinary stones with MPCNL is characterized by small trauma，less bleeding and fewer complications．It is worthy to be recommended in grass-roots hospitals．

【Key words】Upper urinary stones; Percutaneous nephrolithotomy;Treatment outcome

微创经皮肾镜(mininmally invasive per-cutaneous，MPCNL)是治疗上尿路结石的最佳治疗方法之一，因其创伤小，取临床应用管理办法》使用抗菌药物。(2)品种交替使用，医师转班相互沟通不够。(3)患者自行要药，这也是造成不合理用药的原因之一。建议持续加强对《处方管理办法》、《抗菌药物临床应用指导原则》的学习，提高处方质量，规范处方管理，促进临床合理用药，儿科抗菌药物的使用率是降低门诊抗菌药物使用率的关键，应强化儿科抗菌药物的规范使用;加强合理用药大众宣教;药师把好审方这一关，严格执行“四查十对”制度，加强审查处方的能力，其次及时与临床医师沟通，避免不合理用药;再次提高处方质量，我院仍需继续采取积极有效的干预措施，使药品的应用更加安全、有效、经济、合理，以提高临床安全用药水平。