“无管化”微通道经皮肾镜取石术治疗上尿路结石68例临床观察

目的 评价“无管化”微通道经皮肾镜取石术(MPCNL)治疗上尿路结石临床疗效、安全性和可行性.方法 用“无管化”MPCNL方法治疗上尿路结石患者68例,其中肾结石患者41例和输尿管上段结石27例,结石最大直径均≤3 cm,术后不留置肾造瘘管,取石后常规留置双“J”管和导尿管.结果 68例患者术中出血量约30～80 mL,平均55 mL,手术时间35～75 min,平均(52.5±3.3)min,结石清除率为95.6％(65/68),3例结石残留(术后2d复查B超提示残留结石直径为3.1、2.8、2.5 mm),术后未出现尿外渗、肾周血肿、感染等并发症;术后住院时间3～5d,平均(4.0±1.2)d,出院后1个月和3个月复查,无结石复发,肾周无肾性囊肿,肾积水均有不同程度减轻.结论 “无管化”MPCNL由于选择了合适的患者,降低了术中的风险性,结石清除率高、术中出血量少、术后并发症少、恢复快,因此是安全有效且可行的,具有非常肯定的临床应用价值,值得进一步推广应用.

Clinical efficacy of 68 cases tubeless microchannel percutaneous nephrolithotomy in the treatment of 68 patients with upper urinary calculi

Objectives To evaluate the efficacy,safety and feasibility of tubeless microchannel percutaneous nephrolithotomy(MPCNL).Methods 68 patients with upper urinary calculi were treated with tubeless MPCNL.Among them,there were 41 cases of renal calculi,27 eases of upper ureteric calculi.The max diameter of calculi was no more than 3 cm.All patients were retained conventional double-J tube and catheter indwelling without nephrostomy fistula after operation.Results Blood loss of patients was 30 ～80 mL(average 55 mL),the operation time was 35 ～ 75 min average (52.5 ± 3.3) min].The stone-free rate was 95.6％ (65/68),and 3 patients with calculi residual calculi residual by B ultrasound after 2 days,the diameter of the calculi was (3.1,2.8,2.5) mm.Of all the patients,there were no complications such as urine leakage,perirenal hematoma and postoperative infection.The hospital stay after operation was 3 ～ 5 d average (4.0 ± 1.2) d].There was no recurrence of calculi,hydronephrosis following up 1 and 3 months.Conclusions The tubeless MPCNL has advantages of low risk,higher stone-free rate,less blood loss,less complications,quicker recovery.The tubeless MPCNL should be a safety and effective method for patients with upper urinary calculi,which could be worth clinical extensive application.