无管化微通道经皮肾镜取石治疗肾结石临床疗效观察

目的:评价"无管化"微通道经皮肾镜取石术MPCNL治疗肾结石临床的安全性和有效性。方法:应用"无管化"MPCNL方法治疗肾结石患者53例,其中肾盂结石患者33例和肾盏结石20例,结石最大直径均≤3cm。术前行结石CT三维重建,术中结合超声检查残留结石,术后不留置肾造瘘管,留置导尿管3～5天后拔除,双"J"管术后21～30天拔除。结果:53例患者术中出血量约50～120mL,平均85mL,未出现肾脏集合系统穿孔及大出血;手术时间40～70分钟,平均55分钟。对于部分患者残留结石行体外冲击波碎石(ESWL);术后并发高热1例,经对症处置缓解。未出现尿漏、肾周血肿等并发症;术后住院时间7～10天,平均6.5±2.1天。出院后1个月和3个月复查,结石清除率96%,肾周无肾性囊肿,肾功不全患者均不同程度减轻。结论:"无管化"MPCNL方法治疗肾结石安全有效、结石清除率高、并发症少、术中出血量少、手术时间短、患者恢复快,有一定的临床应用价值,值得推广应用。

The Clinical Efficacy of Ductless Microchannel Taking the Stone Kidney Stones by Percutaneous Nephrolithotomy

Objective:Evaluation of the " No tube" micro channel percutaneous nephrolithotomy MPCNL treatment of renal calculi clinical safety and efficacy.Methods:Application of " no pipe of the" MPCNL method in the treatment of renal calculi in 53 cases,The pelvis calculi in 33 cases and 20 cases of renal calyceal stones,Maximum diameter less than or equal to 3cm calculus,Preoperative stones CT three-dimensional reconstruction,Intraoperative residual stones combined with ultrasound,Postoperative not indwelling nephrostomy fistula,Indwelling catheter after removal of 3 ～5D,Double "J" pipe postoperative 21-30 d pull out.Results:In 53 patients with bleeding volume of about 50 ～ 120mL,The average 85mL.No perforation and hemorrhage of kidney collecting system,Operation time 40 ～ 70min,The average 55min.For some patients with residual stones with extracorporeal shock wave lithotripsy(ESWL).Postoperative high fever in 1 cases,after symptomatic disposal alleviate.Did not appear urinary leak,kidney weeks complications,such as the hematoma.Postoperative hospital stay was 7～ 10D,Average(6.5 +2.1) d.1 months after discharge and 3 months.Stone clearance rate was 96%,Peripheral kidney without renal cyst.Renal insufficiency patients have varying degrees of ease.Conclusion:"No tube of the" MPCNL method to treat kidney stones is safe and effective,A higher stones clearance,Less complications,Fewer complications,Less peri-operative bleeding,Operation time is short,Patients recover quickly,Have certain value of clinical application,It is worthy of popularization and Application.