斜卧位微创经皮肾镜治疗上尿路结石

目的探讨斜卧位微创经皮肾镜碎石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗上尿路结石的可行性。方法 2009年8月-2010年10月,采用斜卧45°体位行MPCNL治疗上尿路结石57例,包括肾结石49例,输尿管上段结石8例。结果 57例均Ⅰ期建立经皮肾通道成功,无穿刺失败或中转开放手术。平均手术时间85 min（45-120min）。一期结石清除率100%（57/57）。肾造瘘管留置时间1-3 d,平均住院时间6 d（4-7 d）。未出现严重并发症。结论斜卧位施行MPCNL手术治疗上尿路结石具有安全、高效、微创的特点,患者体位舒适,便于术中麻醉监测,术中碎石易排出,值得临床推广应用。

Minimally Invasive Percutaneuous Nephrolithotomy at Semi-supine Position for Upper Urinary Calculi

Objective To assess the feasibility of minimally invasive percutaneous nephrolithotomy（MPCNL） for the treatment of upper urinary calculi with the patients at semi-supine position.Methods Between August 2009 to October 2010,we performed MPCNL on totally 57 patients with upper urinary calculi,including 49 cases of renal stones,and 8 cases of upper urethral calculi.The procedure was carried out with the patients at 45° semi-supine position.Results Percutaneous renal channel was established in stage Ⅰ in all the 57 cases without conversion to open surgery or failure.The mean operation time was 85 min（45-120 min）,and stone clearance rate in the first session was 100%（57/57）.Nephrostomy tube was withdrawn in 1 to 3 days after the operation,the mean hospital stay of the patients was 6 days（4-7 days）.None of them showed severe complications.ConclusionsMPCNL with the patients at semi-supine position is safe,effective and minimally invasive for the treatment of upper urinary calculi.The position is helpful for intraoperative anaesthesia monitoring and removing the stones.