超声定位若干问题

1、peking university peoples hospitalurology department 超声定位经皮肾镜技术需超声定位经皮肾镜技术需要注意的若干问题要注意的若干问题peking university peoples hospitalurology department超声定位：超声定位： 简便，快捷简便，快捷 安全，准确安全，准确peking university peoples hospitalurology departmentb b超定位特点超定位特点良好显示透良好显示透x线结石线结石无影像重叠无影像重叠peking university peoples hospita

2、lurology department多角度检查肾脏内多角度检查肾脏内部结构部结构显示结石及与肾脏显示结石及与肾脏的关系的关系观察肾脏毗邻关系观察肾脏毗邻关系peking university peoples hospitalurology department测量目标肾盏至皮肤距离测量目标肾盏至皮肤距离 穿刺路线通过的结构穿刺路线通过的结构彩色超声观察拟定通道上血管走行彩色超声观察拟定通道上血管走行peking university peoples hospitalurology departmentpeking university peoples hospitalurology depa

3、rtmentb b超定位优势超定位优势无射线损害无射线损害对体位不再有特殊要求对体位不再有特殊要求peking university peoples hospitalurology department一、探头与频率一、探头与频率线阵探头与凸阵探头线阵探头与凸阵探头 3.5mhz与5mhz穿刺探头与穿刺支架穿刺探头与穿刺支架peking university peoples hospitalurology department二侧方入针与头端入针侧方入针与头端入针peking university peoples hospitalurology department三、超声下目标肾盏的选择三、

4、超声下目标肾盏的选择皮肾距离最短皮肾距离最短最大限度处理结石最大限度处理结石尽可能多的探及到尽可能多的探及到其他组肾盏其他组肾盏peking university peoples hospitalurology departmentpeking university peoples hospitalurology department四、实时超声四、实时超声实时超声监测下实时超声监测下,控制穿刺针方向及控制穿刺针方向及深度深度peking university peoples hospitalurology department肾盏穹窿部入针进入引流系统是减少损伤出肾盏穹窿部入针进入引流系统是

5、减少损伤出血的关键血的关键五、入针点与走行方向五、入针点与走行方向peking university peoples hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospitalurology department 功能性孤立肾肾结石功能性孤立肾肾结石peking university peoples hospitalurology department 下盏穿刺下盏穿刺 中盏穿刺中盏穿刺 调整穿刺点位置与角度避开血管调整穿刺点位置

6、与角度避开血管peking university peoples hospitalurology department六、六、“死角死角”盏结石的处理盏结石的处理超声影像下针辅助移动结石到可视超声影像下针辅助移动结石到可视范围范围软镜取石碎石软镜取石碎石另建通道另建通道peking university peoples hospitalurology department 超声下移动结石超声下移动结石peking university peoples hospitalurology departmentpeking university peoples hospitalurology depa

7、rtment七、超声定位的局限七、超声定位的局限临床医师的熟悉程度临床医师的熟悉程度超声机器分辨率的影响超声机器分辨率的影响取石后大量液体外渗对超声检查取石后大量液体外渗对超声检查的影响的影响扩张过程实时监测的局限扩张过程实时监测的局限两两步法建立标准通道步法建立标准通道peking university peoples hospitalurology department 两步法建立标准通道两步法建立标准通道peking university peoples hospitalurology department 建立通道掌握的原则 peking university peoples hosp

8、italurology department八八 超声定位与标准通道超声定位与标准通道视野清晰视野清晰 可通过多种腔内碎石工具可通过多种腔内碎石工具有效减低肾盂内压力，减少并发症有效减低肾盂内压力，减少并发症避免避免肾盂内压过高造成肾单位损害肾盂内压过高造成肾单位损害入针点是减少手术出血的关键入针点是减少手术出血的关键 peking university peoples hospitalurology department几种特殊情况的超声定位几种特殊情况的超声定位peking university peoples hospitalurology department婴幼儿经皮肾镜婴幼儿经皮肾

9、镜 减少射线辐射减少射线辐射 良好的显示透良好的显示透x线结石线结石peking university peoples hospitalurology departmentpeking university peoples hospitalurology department peking university peoples hospitalurology department七个月大“结石宝宝”peking university peoples hospitalurology departmentpeking university peoples hospitalurology depar

10、tment 6个月婴儿肾结石pnlpeking university peoples hospitalurology department伴脊柱畸形上尿路结石经皮肾镜伴脊柱畸形上尿路结石经皮肾镜peking university peoples hospitalurology department严重脊柱畸形严重脊柱畸形pnlpnl的相对禁忌征的相对禁忌征 (aua(aua指南指南) ) peking university peoples hospitalurology department 定位问题定位问题 邻近脏器损伤问题邻近脏器损伤问题peking university peoples

11、hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospitalurology departmentpeking university peoples hospi