微创经皮肾结石切开取出术治疗复杂性上尿路结石106例疗效分析

目的　探讨腔镜治疗复杂性上尿路结石的方法和疗效 ,提高治疗水平。方法　B超引导经皮肾穿刺建立 16F大小皮肾通道 ,使用 8/ 9 8F输尿管肾镜 ,结合电子弹道碎石 ,经皮肾通道治疗复杂性肾结石5 0例、输尿管上段结石 5 6例。结果　Ⅰ期肾穿刺取石术 98例 ,Ⅱ期取石术 8例 ,无中转开放性手术。建立一通道 96例 ,二通道 8例 ,三通道 2例。手术时间 0 5h～ 3 5h ,平均 2 0h。肾结石取净率 88% ,结合ESWL治疗肾结石清除率 94 % ,输尿管结石取净率 10 0 %。术中输血 2例。拔除输尿管后需相应手术治疗处理肾输尿管病变 3例。结论　微创PCNL疗效确切 ,创伤小、康复快、并发症少 ,配合ESWL可进一步提高疗效 ,是治疗复杂性肾、输尿管上段结石的理想方法 ,值得推广应用

TREATMENT OF UPPER URINARY COMPLEX CALCULI WITH MINI-PERCUTANEOUS NEPHROLITHOTOMY:REPORT OF 106 CASES

Objective To evaluate the feasibility and availability of minimally invasive percutaneous nephrolithotomy(m-PCNL) in treating upper urinary complex calculi. Methods A total of 106 patients suffering from upper urinary complex calculi who were treated with m-PCNL. Of 106 cases, renal calculi was in 50 cases and upper ureteral caculi in 56. Percutaneous nephrostomy was established solely under the guide of B-ultrasound. The renal tract was dilated to 16F in diameter. A 8/9.8F ureteroscope and endourological electrokinetic lithotripsy were used through a Peelaway sheath to manage the calculi. Results 98 cases uderwent one stage procedure, another 8 cases underwent two stages. No case changed to open operation during the procedure. Single tract was in 96 cases, two tracts in 8 cases, three tracts in 2 cases respectively. The mean surgical time was 2.0 hours. 88% renal calculi were free after procedure, 6 patients underwent ESWL for residual fragments, so the renal stone clearance amounted 94%. 100% upper ureteral caculi were rendered stone-free at 1 session. 2 cases had transfusion intra-operatively. 3 patients needed open surgery for renal or ureteral complications after indwelling stones removal. Conclusions Minimally invasive percutaneous nephrolithotomy is safe and effect in treating upper urinary complex calculi, with high stone free rate, less invasion, little complications and easy recovery. It is highly recommended.