经皮肾穿刺取石术治疗上尿路结石(20年经验)

目的:对我院20年来使用经皮肾穿刺取石术(percutaneous nephrolithotomy,PCNL)治疗上尿路结石的经验进行总结,评价其临床疗效及安全性.方法:用经皮肾穿刺取石术共治疗上尿路结石4 014例,其中采用传统PCNL治疗358例,经皮肾微造瘘二期输尿管镜取石治疗520例,微创PCNL治疗3 136例.结果:三种方法手术成功率分别为90%、95%和98%,结石清除率分别为82%、86%和91%,严重并发症发生率分别为5.3%、1.2%和0.5%;其中单通道取石3 027例,多通道取石987例,手术例次共5 571次.结论:通过对经皮肾穿刺取石术的不断改进与创新,提高了该项技术的手术成功率与结石清除率,降低了并发症,扩大了其临床适应证.

Treatment of upper urinary calculi with the PCNL technique (Experience of 20 years )

Objective: To sum up experience of 20 years for treating upper urinary calculi with percutaneous nephrolithotomy (PCNL) at our institute and assess the safety, feasibility and superiority of the technique. Methods: We retrospectively investigated 4 014 patients suffering from upper urinary calculi, who were treated with PCNL ,of 4 014 cases, traditional PCNL was performed in 358, two stage "mini perc" technique in 520 and minimally invasive PCNL in 3 136. Results: The success rates were 90%, 95% and 98%, the stone free rates were 82%, 86% and 91%. Major complications rates were 5.3%, 1.2% and 0.5%, respectively,with single tract in 3 027 cases,and mutiple tracts in 987 cases. A total of 5 571 PCNLs were performed in 4 014 patients. Conclusion: By improvement and innovation of this technique, percutaneous nephrolithotomy can reach the high success rate and stone free rate, with less morbidity,and wide clinical indications.