经皮肾微造瘘输尿管镜钬激光碎石术治疗上尿路结石

目的探讨经皮。肾微造瘘输尿管镜钬激光碎石术治疗上尿路结石的临床效果。方法本组152例159侧，年龄16～77岁，平均39．8岁。先取截石位，在膀胱镜下向患侧输尿管置入6F输尿管导管至肾盂或输尿管上段结石处，制成人工肾积水后改俯卧位，经皮肾穿刺扩张至16F后置入输尿管镜，看清结石后直视下行钬激光碎石。结果152例患者159侧均一期建立经皮肾通道成功，双侧结石患者分次手术，无一例改行开放手术。术后复查，一期手术结石取净率为84．4％（92／109），二期手术后总结石取净率为88．1％（140/159）。术中无气胸、腹腔脏器损伤、大出血发生。结论经皮。肾微造瘘输尿管镜钬激光碎石术治疗肾、输尿管上段结石具有安全实用、损伤小、并发症少、取石效率高、手术及住院时间短、可重复操作穿刺取石等优点，特别对于开放取石术后残留、复发结石和并发梗阻、肾功能不全者明显优于其他方法，值得推广应用。

Minimally invasive percutancous lithotripsy with ureteroscope holmium laser for the treatment ofupper urinary calculi

Objective To explore the clinical value of minimally invasive percutancous lithotripsy （MPCNL） with ureteroscope holmium laser lithotripsy for the treatment of upper urinary calculi. Methods 152 cases and 159 sides, mean age was 39.8 years old. 6F ureter catheter was inserted to upper ureter or renal pelvis when patients were all placed in lithotomy position, then turned into prone position and underwent percutancous ureteroscope holmium laser lithotripsy. Reaulta All of 152 cases and 159 sides had successful percutancous channels at one-stage, double-sides patients underwent two-step procedure. The stone clearance rate of one-stage was 84.4% （92/109） and total clearance rate after second operation was 88.1% （140/159）, and there was no pneumothorax,peritoneal organs injury and hemorrhage.Coacluaion Percutancous ureteroscope holmium laser lithotripsy has many advantages, such as high-efficient, pratical, repeatable and minimal invasive, especially for those residual stones ,recurrent calculus after open-operation and complicated with obstruction and renal insufficiency. Percutaneous ureteroscope holmium laser lithotripsy is one of methods worthy of extension and application.