微创经皮肾镜取石术治疗上尿路结石68例体会

目的 探讨微创经皮肾镜取石术治疗上尿路结石的临床效果.方法 回顾性分析2009年9月至2013年6月我院经皮肾穿刺建立F16-20通道、输尿管硬镜下钬激光碎石术治疗的68例上尿路结石患者的临床资料.结果 合并糖尿病患者中1例因穿刺后出血留置肾造瘘管,夹闭后观察均无明显出血,1周后碎石取石成功;2例患者术中穿刺后流出浑浊尿液,肾造瘘引流2周后碎石取石成功;1例术后出血,介入栓塞治疗痊愈;其他患者均一次穿刺成功,顺利碎石取石.3例手术当天发热超过38.5℃,无胸膜损伤、气胸、腹腔脏器损伤、术中大出血、术后迟发性大出血、造瘘管滑脱以及术后感染等并发症.结论 微创经皮肾镜碎石取石术治疗上尿路结石安全有效,并发症较少,值得进一步推广应用.

Experience of doctoring 68 patients for upper urinary tract calculi by minimally invasive percutaneous nephrostolithotomy

Objective To study the effect of minimally invasive percutaneous nephrolithotomy in treatment of upper urinary tract calculi. Methods To retrospective analysis the clinical data of 68 cases of patients with upper urinary calculi treatment by percutaneous renal to set up a F16-20 channel and smashing the calculi under ureteroscope with holmium laser lithotripsy, who received treatment in our hospital from September 2009 to June 2013. Results One diabetes patient hemorrhaged after puncture, so we placed renal fistula and observed no significant bleeding after closed the fistula, then the operation again was successful after one week; turbid urine outflow from two patients after puncture, so we also placed renal fistula and the operation again was successful after two weeks; one patient bleed after operation, we staunched successfuUy the bleeding by interventional therapy. The other patients＂ operations were all successful at the first time. Three patients fevered over 38.5℃ at the operation day, who were no other complications such as pleural lesions, pneumothorax, abdominal visceral injury, intraoperative bleeding and postoperative late-onset bleeding, fistula slippage and postoperative infection. Conclusions Minimally invasive percutaneous nephrostolithotomy for upper urinary calculi was safe and effective, and the complication was lesser, so it was worthy of further popularization and annlication.