斜卧位微通道经皮肾穿刺取石术治疗嵌顿性输尿管上段结石61例分析

目的探讨斜卧位经超声引导行微通道经皮肾穿刺取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)治疗嵌顿性输尿管上段结石的安全性和可行性。方法术前患侧输尿管逆行插管,患侧向上45°斜卧位,肩部及臀部用软垫支撑。经超声引导进行穿刺、扩张建立F16～F18经皮肾通道,采用输尿管镜钬激光碎石取石。结果 61例手术均获成功,无穿刺失败和中转开放手术者。术中出血量20～150 ml,平均75 ml。手术时间35～105 min,平均60 mim。一期结石清除率93.4%(57/61)。61例随访1～6个月,平均3个月,B超或KUB检查无结石残留。结论斜卧位经超声引导下行MPCNL,患者体位舒适,超声引导可提高穿刺成功率,有效避免并发症,一期结石清除率高。

Mini-percutaneous Nephrolithotomy at Semi-supine Position for Upper Ureteral Incarcerated Stone:Analysis on 61 Cases

Objective To evaluate the safety and feasibility of minimally invasive percutaneous nephrolithotomy(MPCNL) for patients with upper ureteral incarcerated stones in a semi-supine position.Methods We performed MPCNL at semi-supine position(45 degrees) on 61 patients with upper ureteral incarcerated stones.A ureteral catheter was inserted retrogradely preoperation,the shoulder and haunch of the patients were supported with a soft pad.Ultrasonic-guided puncture and a F16 to F18 channel was made for ureteroscopic lithotripsy with holmium laser.Results Lithotripsy was successfully completed in all the 61 cases without conversion to open surgery.The intraoperative blood loss was 20-150 ml(75 ml in average).The operation time ranged from 35 to 105 min with a mean of 60 min.One-session stone-clearance rate was 93.4%(57/61).The patients were followed up for 1-6 months(mean,3 months),during which B-ultrasonography or KUB showed no residual stones.Conclusions With semi-supine position,patients feel comfortable during MPCNL.Ultrasonic-guided can increase the success rate of puncture,and avoid complications so that to increase stone-clearance rate in the first session.