微创经皮肾镜上盏入路取石术治疗复杂性肾结石

【目的】探讨经上盏入路微创经皮肾镜气压弹道碎石取石术（mPCNL）治疗复杂性肾结石的可行性与效果。【方法】经上盏入路行mPCNI。治疗153例复杂性肾结石患者，采用单通道取石132例（86．3％），采用双通道取石21例（13．7％）。【结果】结石取净141例（92．2％），其中一期取净结石121例（79．1％，121／153）；32例残石患者30例二期取石，其中18例取净（60％，18／30）；余12例残石患者9例三期取石（5．8％，9／153），2例取净（22．2％），最后有12例结石残留（7．8％，12／153）。1例出现轻微液气胸，自愈。手术时间为30～173min，术中出血量约10～300mL，无输血、肾切除、感染性休克等并发症。【结论】采用经上盏入路行PCNL术治疗复杂性肾结石具有创伤小、穿刺扩张容易、出血少、视野广、结石取出率高、恢复快等优点。

Minimally Invasive Percutaneous Nephrolithotomy by Upper Calyx Approach in the Treatment of Complex Renal Calculi

Objective] To investigate the feasibility and effect of minimally invasive percutaneous nephro lithotomy（mPCNL） by upper calyx approach in treatment of complex renal calculi. Methods] mPCNL by upper calyx approach was used in the treatment of 153 patients with complex renal calculi. Of the patients, 132 patients（86.3%） were treated by single channel lithotripsy and 21 patients（7.8%） were treated by double channel lithotripsy. Results]In 141 patients（92.2%, 141/153） with stone-free, 121 patients（79. 1%） were stone-free at the first stage. Of 32 patients with residual stone, 30 patients（19.6%,30/153） were treated at the second stage in which 18 patients （60%, 18/30） were stone-free. After treatment at the second stage, in 12 patients with residual stone, 9 patients（5.8% ,9/153） were treated at the third stage in which 2 patients （22.2%,2/9） were stone-free. Totally 12 patients（7.80//oo） had residual stone. One patient had light hydro-pneumothorax, and then was cured by self. The operation time was 30~ 173rain. The volume of bleeding was 10-300mL. There was no complication such as blood transfusion, nephrectomy and infectious shock. Con clusion] mPCNL by upper calyx approach for the treatment of complex renal calculi has advantages of minimal trauma, easy puncture, a little bleeding, wide vision, high stone-free rate and fast recovery and so on.