经皮肾镜取石术治疗鹿角形肾结石通道建立技巧的探讨

目的：探讨经皮肾镜取石术（PCNL）治疗鹿角形肾结石术中穿刺点、穿刺径路的合理选择及扩张、通道建立的技巧。方法：总结在X线定位下PCNL治疗36例鹿角形肾结石患者的经皮肾通道建立与治疗效果。结果：Ⅰ期手术穿刺、通道建立、成功碎石率100％；Ⅰ～Ⅲ期结石完全清除率83．33％；单通道26例（72．22％），双通道7例（19．44％），三通道3例（8．33％）；无大出血、感染休克等严重并发症发生。结论：PCNL治疗鹿角形肾结石的第一个穿刺点首选中后组盏，径路应与目标盏长径相吻合；带鞘扩张时扩张器应进入集合系统内约2cm，退出扩张器直接完成通道建立；Ⅰ期建立单通道处理。肾盂、中组肾盏结石为主，Ⅱ期先经Ⅰ期通道处理上下盏残留结石，慎重建立第二、三条经皮肾通道。

Skills of Developing Renal Tract in Percutaneous Nephrolithotomy to Treat the Renal Staghorn Calculi

Objective：To discuss the skills of puncture point choice, puncture track, percutaneous enlargement and developing renal tract in percutaneous nephrolithotomy （PCNL） to treat the renal staghorn calculi. Methods： The renal percutaneous track skills and treat effect in 36 patients of staghorn calculi with PCNL under X-ray were analysed. Results：The rate of puncture, track performing and successful stone lithotripsy was 100%. Overall stone clearance in Stage Ⅰ～Ⅲ was 83.33%, including 26 patients（72.22%） with single tunnel,7 patients （19.44%% with double tunnels,3 patients （8.33% ） with three tunnels without severe complications such as hemorrhage,septic shock and et al. Conclusions：The first puncture point prior to choose middle calyx puncture approach in PCNL to treat the staghorn calculi, and the puncture track should be accorded to the long tract in target renal calyx. The delator with the sheath shoud be punctured in the renal collective system 2era, then took throghback the delator and create the track. The calvic and middle calyx stones were deeled with in Ⅰ stage and the remained stones in the up and the lower calyx were deeled with in Ⅱ stage. The second and the third percutaneous tunnels should be created gingerly.