经皮肾微造瘘吸引碎石清石鞘在微创经皮肾镜取石术中的应用

目的：探讨应用专利设计的经皮肾微造瘘吸引碎石清石鞘（简称专利鞘）治疗上尿路结石的临床疗效和安全性.方法：回顾性分析2008年8月～2009年10月应用专利鞘行微创经皮肾镜取石术（MPCNI.）治疗上尿路结石患者198例的临床资料,其中肾结石138例,输尿管上段结石46例,单侧肾结石并同侧或对侧输尿管结石12例,双肾结石并双侧输尿管上段结石2例.均应用专利鞘进行MPCNL,并对手术时间、肾盂内压、清石率、手术并发症等进行分析.结果：198例均一期建立通道.采用单通道取石192例,双通道取石5例,三通道取石1例.平均手术时间（46±10.8）min,术中监测肾盂内压力平均（0.28±0.068）kPa（1 mmHg=0.133 kPa）;术后血红蛋白含量较术前平均下降（4.2±1.5）%,术中输血5例,术后2例出血严重者经高选择性肾动脉栓塞治愈.一期清石率为95.95%.术后3天出现体温≥38.5℃者3例.结论：应用专利鞘行MPCNL治疗上尿路结石安全、高效,临床效果显著.

Application of Patented Sheath in Invasive Percutaneous Nephrolithotomy

Objective： To evaluate the efficacy and safety of invasive percutaneous nephrolithotomy using patented sheath in treating upper urinary tract calculi. Methods：We retrospectively analyzed 198 patients from August 2008 to October 2009 who underwent pereutaneous nephrolithotomy using patented sheath under ultrasound guidance for upper urinary tract calculi, including 138 cases renal calculi, 46 cases upper ureteral calculi, 12 cases for one side renal calculi with same or contralateral ureteral calculi were, 2 cases for double side renal calculi with double side ureteral calculi. The mean operating time, mean renal pelvic pressure, phase I stone free-rate and complications were analyzed. Results： The percutaneous renal access was successfully established in 198 patients and immediate lithotripsy was performed. Single tract was used in 192 cases, double tract were used in 5 cases and one patient was treated with triple tracts. The mean operating time was （46± 10.8）min, mean renal pelvic pressure was（0.28± 0. 068） kPa（ 1 mmHg= 0. 133 kPa）, mean hemoglobins decreased（4.2 ± 1.5）%. Five cases needed transfusion, 2 cases underwent hyperselective angioembolization for bleeding control. The phase-I stone free-rate was 95.95%. 3 patients had high fever after surgery. Conclusions：The treatment of upper urinary tract calculi by percutaneous nephrolithotomy using patented sheath appears to be safe and efficacious.