B超联合X线引导下微创经皮肾镜治疗复杂性肾结石

【摘要】目的探讨B超X线联合引导下微创经皮肾镜（minimally invasive percutaneous nephrolithotomy，MPCNL）治疗复杂性肾结石的方法、可行性及临床应用价值。方法对本院38例接受B超x线联合引导MPCNL治疗的复杂性肾结石患者的基本资料、结石大小、手术时间、出血量、结石清除率及并发症等进行回顾性分析。结果38例均在B超X线联合引导下准确建立理想工作通道，单通道取石28例，双通道10例，一期结石清除率为82．4％（32／38），平均手术时间为95min，术中平均出血量为110mL，平均住院时间为12d。术后6例行二期碎石，仅2例残留盏内小结石渣，结石总清除率为94．7％。本组均未发生严重感染、大出血等并发症。结论采用B超联合X线引导下MPCNL治疗复杂性肾结石安全、有效，可明显提高穿刺成功率和一期结石清除率，并减少并发症，值得临床推广应用。

Minimally invasive percutaneous nephrolithotomy guided by B-ultrasound and X-ray in treatment of complex renal calculi

Objective To investigate the method, feasibility and clinical application value of minimally invasive percu- taneous nephrolithotomy （MPCNL） guided by B-ultrasound and X-ray in the treatment of complex renal calculi. Meth- ods Thirty-eight cases of patients with complex renal calculi were treated by MPCNL guided by B-ultrasound and X- ray in our hospital, the clinical data were retrospectively analyzed, such as basic information, stone size, operation time, bleeding volume, stone-free rate and complications. Results Thirty-eight cases were accurately established ideal working channel guided by B-ultrasound and X-ray, with single tract percutaneous neph rolithotomy in 28 cases, dou- ble tract in 10 cases. The stone free rate was 82.4% （32/38） at one-stage, the average operation time was 95 rain, the mean intraoperative bleeding was 1 l0 mL, the average hospitalization time was 12 day. After operation, 6 cases under- went two-stage lithotripsy, small stone slag in renal calices left over in 2 cases only, and the total stone free rate was 94.7%. There was no serious infection, massive hemorrhage, and other complication. Conclusion MPCNL guided by B-ultrasound and X-ray is safe and effective to treat complex renal calculi. It can significantly improve the success rate of puncture and the stone-free rate at one-stage, and reduce complications. So it is worthy of clinical application.