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【Objective】 To explore the causes and management of nephrostomy catheter following percutaneous nephrostolithotomy (PCNL) entering the inferior vena cava. 【Methods】 A retrospective analysis was performed on the management of two cases of nephrostomy catheter entering the inferior vena cava. The causes, changes of minimally invasive treatment and prevention plans were discussed. 【Results】 Two patients underwent digital subtraction angiography (DSA) to restore the nephrostomy tube to the renal pelvis collecting system. No renal vein rupture or bleeding occurred during the operation, and the patients’ vital signs were stable. Nephrostomy tube was removed successfully after operation. The wound healing was good, and there was no secondary hemorrhage such as perirenal hematoma. The prognosis was good. 【Conclusion】 Although intravenous nephrostomy tube misplacement is an uncommon PCNL complication, the consequences are serous. One-step retraction displacement of nephrostomy tube to the renal collecting system can effectively manage nephrostomy catheter entering the inferior vena cava.
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Objective To observe the clinical effect of dexmedetomidine for preventing agitation during extubation period in the patients undergoing percutaneous nephrostolithotomy.Methods Sixty ASA Ⅰ-Ⅱ patients with elective percutaneous nephrostolithotomy under general anesthesia were selected and randomly assigned to the dexmedetomidine (DEM) and normal saline group (NS),30 cases in each group.The DEM group was given dexmedetomidine 0.5 μg/kg by intravenous pumping at 30 min before the end of the operation,while the NS group was given the equal volume of normal saline by intravenous pumping for 10 min.MAP and HR were recorded before anesthesia induction(T0),at the end of skin suturing(T1),at the moment of extubation(T2),at 5 min (T3) and 10 min(T4)after extubation.The eye opening time and extubation time,and incidence of agitation were observed in the two groups.Results MAP and HR at T2,T3 and T4 in the DEM group were lower than those in the NS group(P＜0.05).MAP and HR at T2,T3,T4 in the NS group were higher than those before anesthesia induction(P＜0.05).The total incidence rate of agitation during extubation period in the DEM group was also significantly lower that that in the NS group(P＜0.01).No statistically significant differences were found between the two groups in the recovery time and extubation time(P＞0.05).Conclusion Intravenous pumping of dexmedetomidine 0.5 μg/kg at 30 min before the end of percutaneous nephrostolithotomy can effectively reduce the occurrence of agitation during extubation period.
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Objective To observe the clinical effect of dexmedetomidine for preventing agitation during extubation period in the patients undergoing percutaneous nephrostolithotomy.Methods Sixty ASA Ⅰ-Ⅱ patients with elective percutaneous nephrostolithotomy under general anesthesia were selected and randomly assigned to the dexmedetomidine (DEM) and normal saline group (NS),30 cases in each group.The DEM group was given dexmedetomidine 0.5 μg/kg by intravenous pumping at 30 min before the end of the operation,while the NS group was given the equal volume of normal saline by intravenous pumping for 10 min.MAP and HR were recorded before anesthesia induction(T0),at the end of skin suturing(T1),at the moment of extubation(T2),at 5 min (T3) and 10 min(T4)after extubation.The eye opening time and extubation time,and incidence of agitation were observed in the two groups.Results MAP and HR at T2,T3 and T4 in the DEM group were lower than those in the NS group(P＜0.05).MAP and HR at T2,T3,T4 in the NS group were higher than those before anesthesia induction(P＜0.05).The total incidence rate of agitation during extubation period in the DEM group was also significantly lower that that in the NS group(P＜0.01).No statistically significant differences were found between the two groups in the recovery time and extubation time(P＞0.05).Conclusion Intravenous pumping of dexmedetomidine 0.5 μg/kg at 30 min before the end of percutaneous nephrostolithotomy can effectively reduce the occurrence of agitation during extubation period.
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Objective To investigate the effect of dexmedetomidine on renal function during percutaneous nephrolithotomy under general anesthesia in the patients with renal calculus. Methods Thirty patients (male 25 cases,female 5 cases)with renal calculi,age 40-70 yr,with body mass index of 1 9-27 kg/m2 ,ASA physical status Ⅰ or Ⅱ,scheduled for elective percutaneous neph-rolithotomy under general anesthesia,were randomized into two groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In patients of group D,dexmedetomidine 1 μg/kg were infused intravenously over 10 min before induction anesthesia,followed by infusion at a rate of 0.5 μg·kg-1 ·h-1 until the end of operation.The equal volume of normal saline was given in pa-tients of group C.Immediately before beginning of surgery (T0 ),at the end of surgery (T1 ),the first day after surgery (T2 )and the third day after surgery (T3 ),blood and urine samples were obtained. The serum and urine concentrations of urea nitrogen (BUN),serum creatinine (Scr),cystatin C (CYS-C),retinol binding protein (RBP),urinaryα1-microglobulin (α1-MG),urine micro-albumin,u-rinary transferrin,urinary immunoglobulin G was measured by automatic biochemical analyzer and Beckman specific protein analyzer.Results There was no difference in BUN and Scr at any time point between the two groups.Compared with T0 ,CYS-C and RBP at T1-T3 increased significantly in two groups (P <0.05).The levels of CYS-C and RBP in group D were lower than in group C at T1-T3 (P<0.05).There was no difference in urinary immunoglobulin G,urine micro-albumin after the start of surgery.Compared with T0 ,urinary α1-MG at T1-T3 increased significantly in two groups (P <0.05).The level of urinary α1-MG in group D was lower than in group C at T1-T3 (P < 0.05 ). Conclusion Dexmedetomidine(1 μg/kg infused intravenously before induction of anesthesia,followed by infusion at a rate of 0.5 μg·kg-1 ·h-1 until the end of operation)might provide renal protection to some extent during percutaneous nephrolithotomy under general anesthesia in the patients with renal calculi.
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Objective To investigate the efficacy of percutaneous renal access with balloon dilation for staghorn calculi.Methods Eighty-nine cases with PCNL were enrolled from February 2012 to March 2015.Clinical data including the time for setting the renal access, operation time, residual stone rate, complications were analyzed.Results Eighty-nine cases established nephrostomy tracts successfully.The average time for setting the renal access was (5.7 ± 1.0) min (4-8 min).The average of operation time was (62.6 ± 14.1) min (37-87min).The average of Hemoglobin decline rate was (6.3 ± 2.5)％ (2.8％-16.9％).The residual stone rate was 12.5％.Conclusions PCNL with ballon dilation is a fast, safe and effective means for staghorn calculi.It is worth using for staghorn calculi.
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Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy(PCNL) by middle renal calice used as main access for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.The rate of stone removal and complications were the main points of the analysis.Results Seventy-two cases underwent first session PCNL by single access tract(middle calices),3 cases underwent first session PCNL by double access tracts (2 cases by middle and lower calices,1 case by upper and middle calices).Of these patients,1 case had fragments with no further treatment,16 cases underwent second session PCNL.All were treated by single access tract (middle calices) and 2 cases had extracorporeal shock wave lithotripsy before the second PCNL.Seventy-six cases composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stones removal rate 82.6％ (76/92).Hemoglobin dropped 1-4 g/L,11 cases and 3 cases were given blood transfusion in the operation procedure and post operation respectively.One case developed pyelonephritis and 1 case had split renal dysfunction with peri-parenchyma infection.Conclusions By middle calices as a main access to perform PCNL for staghorn stones is effective and safe.Using pneumatic and ultrasonic lithotrite will be very useful with high stones free rate and short procedure time and less complication.
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Objective To discuss the reasons and management of renal vein injury during percutaneous nephrostolithotomy (PCNL). Methods From 2007 to 2008 renal vein injury was caused in two patients by malposition of nephrostomic catheter in our hospital. The two patients were both males, aged 61 years old and 41 years old. They underwent PCNL due to left kidney stones. The percutaneous nephrostomy (PCN) catheters were malpositioned into the left kidney vein and vena cava, which was confirmed by prograde radiography and spiral CT scan after operation. The PCN catheter in the 41 years old patient was pulled back to renal collecting system on the 7th day, and was extracted on the 10th day under X-ray monitoring. The PCN catheter in the 61 years old patient was pulled back to the renal collecting system on the 14th day and wasstable extracted on the 18th day under X-ray monitoring. Results The bleeding was controlled and the hemodynamic status in the two cases after removal of PCN catheters. There was no renal arteriovenous fistula bleeding, surgical intervention, kidney infections or further damage of kidney function. Conclusion Renal vein injury during the PCNL can be managed by clamping the PCN catheter and gradual withdrawal. The method is safe and reliable, and it can avoid surgical intervention.
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Objective To assess the efficacy of stone fragmentation and clearance of this new intracorporeal ultrasound lithotripter (CQS-01) compared with currently available ultrasound units (EMS-Ⅲ/Ⅳ).Methods Twenty phantom stones composed of dental gypsum were randomly divided into four groups,and CQS-01 ultrasound lithotripter (70％ power and 70％ duty factor),EMS-Ⅲ ultrasound lithotripter (70％ power and 70％ duty factor),EMS-Ⅳ ultrasound lithotripter (type A,70％ power and 70％ duty factor) and EMS-Ⅳ ultrasound lithotripter (type B,70％ power and 100％ duty factor) were used to fragment and removepbantom stones.The mean stone breakdown time and fragment removal time and stone fragmental sizes for the standard ultrasound devices were compared to determine the completeness and efficiency of stone fragmentation and removal.Results The average time for stone breakdown was 7.4 ± 1.9 s,9.4 ± 1.6 s,82.2 ± 12.6 s and 51.4 ± 18.7 s,respectively.There was no significant difference between CQS-01 and EMS-Ⅲ (P ＞ 0.05),but there was significant difference between CQS-01 and EMS-Ⅳ (A or B) (P ＜ 0.001).The average time for stone clearance using the ultrasound devices was 387.8 ± 68.0 s,41 1.6 ± 57.6 s,568.0 ± 119.1 s and 383.6 ± 75.6 s,respectively.In addition,the average size of the largest fragments removed was the same among the groups (＜ 3 mm).Conclusion The ultrasound capabilities in a newly developed lithotriter (CQS-01) exhibited the same ability to fragment and clear phantom stones compared with standard ultrasound devices.
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Objective To analyze the risk factors of fevers after percutaneous nephrostolithotomy (PCNL) and to determine a more effective prophylaxis method.Methods A retrospective analysis of 320cases who underwent PCNL for renal calculi from 2008 to 2011 (men 233,women 87,age between 22 years to 72 years) was made.The average age of the patients and the average diameter of the stones were 42 years and 3cm(0.8 -6 cm),respectively.We analyzed factors such as age ( ＞60 years and ≤60 years),stone size ( ＞2.0 cm and ≤2.0 cm),operative time ( ＞60 min and ≤60 min),irrigation pump pressure ( ＞120 mm Hg and ≤ 120 mm Hg),obstructive conditions,preoperative urinary tract infection and fever.Wethen compared the fever rate with each of the risk factors.Results There were 59 cases with fever after PCNL; 18.4％ of the cases had a temperature over 38 ℃.There were two cases of pyemia.The patients whose stone diameter ＞ 2 cm had a post-operative fever rate of 22.4％.The fever rate in patients whose stone diameter ≤2.0 cm was 10.4％.The fever rate in patients with an operative time ＞60 min and ≤60 min was 27.2％ and 10.4％,respectively.Patients with irrigation pump pressure ＞ 120 mm Hg and ≤ 120mm Hg had post-operative fever rates of 28.3％ and 11.0％,respectively.There was statistical significance between each post-operative fever risk factor group.Conclusions The post PCNL fever risk factors are stone diameter ＞ 2.0 cm,operation time ≤60 min and irrigation pump pressure ＞ 120 mm Hg.The effective prophylaxis policy of post-operative fever are the pre-operative using of broad-spectrum antibacterial agents,shorter operative time and lower irrigation pump pressure.A two-stage operation procedure will also reduce the post-operative fever.