MPCNL术治疗复杂性肾结石

目的探讨微创经皮肾镜取石术(MPCNL)在处理复杂性肾结石中的价值。方法回顾性分析57例经皮肾穿刺取石术治疗的复杂性肾结石患者,男39例,女18例,平均年龄47岁。多发结石40例(包括鹿角型结石5例),鹿角型结石13例,铸型结石9例。结石长径0.6~5.8cm,平均2.8cm。采用逆行输尿管插管注生理盐水或30%泛影葡胺形成人工肾积水,在B超引导或“C”臂监视下建立经皮肾盂通道。结果一期取石31例,二期取石20例,三期取石6例。单通道取石45例,双通道取石12例。结石清除率达82.4%(47/57)。平均手术时间115分钟,术后平均带管时间6天,术后平均住院时间7.5天。术中出血100~1000ml,术中输血3例,术后并发大出血2例,均经输血等保守治疗治愈,中转开放手术1例。随访2年,结石复发3例。结论MPCNL具有安全、损伤小、出血少、并发症少等优点。是目前解决复杂性肾结石较理想的方法。

Treatment of complex renal calculi with mini-percutaneous nephrolithotomy

Objective To evaluate the feasibility and efficacy of mini-percutaneus enphrolighotomy in the treatment of complies renal calculi. Methods The data of 57 patients with renal calculi who had undergone MPCNL from February 2003 to March 2006 were retrospectively analyzed.The were 39 men and 18 women,The mean age was 47 years.Of the 57 cases,40 had complex upper urinary calculi(including 5 staghorn calculi),22 had staghorn calculi.The mean stone size was range from 0.6cm~5.8cm,the mean size was 2.5cm.Artificial hydronephrosis was formed by the transfusion of normal saline or 30% acetrizoic acid through retrograde catheterization of ureter,build up the tract of MPCNL under the guide of B-ultrasound or C x-ray machine. Results They were treated with one-stage,two-stage,threestage operation respectively was 30,21,6,of which single tract in 45 cases,two tracts in 12.The stone clearance rate was 82.4%,the average operative duration was 115 minutes,the volume of bleeding was 100~800ml.3 cases with blood transfusion and only 2 cases were complicated with severe bleeding after the procedure.Only one patient changed into open surgery.The average duration of renal fertilization tube's removement was 6 days,and mean hospital stay was 7.5 days. 3 patients recur with 2 years of follow-up visit. Conclusion The mini-percutaneous nephrolithtomy is a safe,low bleeding,mini damage,hypo-complications management for complex renal calculi.