【文獻(xiàn)標(biāo)識碼】A

【文章編號】1008-7044(2015)01-0036-03

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

【作者單位】安徽省懷遠(yuǎn)縣第二人民醫(yī)院外二科，233400

【作者簡介】趙廣鋒(1977－)，男，安徽懷遠(yuǎn)縣人，副主任醫(yī)師，大學(xué)。

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

微創(chuàng)經(jīng)皮腎鏡(mininmally invasive per-cutaneous，MPCNL)是治療上尿路結(jié)石的最佳治療方法之一，因其創(chuàng)傷小，取臨床應(yīng)用管理辦法》使用抗菌藥物。(2)品種交替使用，醫(yī)師轉(zhuǎn)班相互溝通不夠。(3)患者自行要藥，這也是造成不合理用藥的原因之一。建議持續(xù)加強(qiáng)對《處方管理辦法》、《抗菌藥物臨床應(yīng)用指導(dǎo)原則》的學(xué)習(xí)，提高處方質(zhì)量，規(guī)范處方管理，促進(jìn)臨床合理用藥，兒科抗菌藥物的使用率是降低門診抗菌藥物使用率的關(guān)鍵，應(yīng)強(qiáng)化兒科抗菌藥物的規(guī)范使用;加強(qiáng)合理用藥大眾宣教;藥師把好審方這一關(guān)，嚴(yán)格執(zhí)行“四查十對”制度，加強(qiáng)審查處方的能力，其次及時與臨床醫(yī)師溝通，避免不合理用藥;再次提高處方質(zhì)量，我院仍需繼續(xù)采取積極有效的干預(yù)措施，使藥品的應(yīng)用更加安全、有效、經(jīng)濟(jì)、合理，以提高臨床安全用藥水平。