微创经皮肾镜取石术治疗上尿路结石

目的 探讨微创经皮肾镜取石术治疗上尿路结石的有效性和安全性.方法上尿路结石患者368例,平均年龄57岁.其中输尿管上段结石116例,结石大小(2.1±0.8)cm;肾结石252例,结石大小(4.6±1.4)cm,其中非鹿角形结石190例,结石大小(3.2±1.1)cm,鹿角形结石62例,结石大小(7.6±1.6)cm.均采用微创经皮肾穿刺,输尿管镜下气压弹道或联合钬激光碎石治疗,对结石清除率和并发症等进行统计分析.结果 368例患者中单通道取石356例(96.7%),双通道12例(3.3%).一期取石344例(93.5%),二期取石24例(6.5%).总结石取净率为88.6%(326/368).平均手术时间73 min.一期取净结石者住院时间4～8 d,平均6 d.术后发热14例(3.8%);输血5例(1.4%);2例肾结石术后出血严重者经输血及超选择性肾动脉栓塞后治愈.结论 微创经皮肾镜取石术损伤小、住院时间短、术中出血及并发症少、结石清除率高、可重复取石,是治疗上尿路结石有效的微创手段.

Treatment of upper urinary tract calculus with minimally invasive percutaneous nephrolithotomy

Objective To assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary tract calculus. Methods The clinical data of 368 cases of upper urinary tract calculus from 2002 to 2006, which underwent mPCNL, were retrospectively analyzed. Among 368 cases analyzed, there were 116 cases with proximal ureteral cal-culus;190 cases of nonstaghorn kidney stones, 62 cases of staghorn stones. Results There were 344 cases(93.5%)treated with one-stage operation, 24 cases(6.5%) with two-stage. Single channel was used in 856 cases(96.70%), two-channel in 12 cases(3.3%). Complete stone clearance was a-chieved in 337 kidneys, giving an overall clearance rate of 91.6%. The average operative time was 73 min. The duration of hospital stay was 4-8 d with an average of 6 d in one-stage and complete clear-ance patients. Postoperative urinary tract infection was seen in 23 patients(6.2 %). Five(1.4 %) pa-tients required blood transfusion after operation. Two patients with severe bleeding were treated with blood transfusion and super-selective arterial embolization. Conclusion mPCNL has definite efficacy in the treatment of upper urinary tract calculus with little suffering and short recovery time.