B超引导下微创经皮肾镜取石术治疗上尿路结石120例临床分析

目的探讨B超引导下微创经皮肾镜取石术(MPCNL)治疗上尿路结石的方法及疗效。方法在B型超声引导下应用MPCNL治疗上尿路结石120例,其中肾鹿角形和多发结石50例,单发肾盂、肾盏结石38例,双肾结石18例,输尿管上段结石14例。结果 120例患者中,118例取石成功,其中95例一期取石成功(包括双通道取石5例),23例二期取石,2例因经皮肾穿失败改行开放手术取石。19例术后仍有残石,给予体外震波碎石或等待观察治疗,平均结石清除率82.5%(99/120)。平均手术时间(90±20)min,平均住院时间(10±2)d,肾造瘘管平均留置时间(4±1)d,双J管平均留置时间4周。8例术后1周内出血较多,其中3例需要输血,5例出现尿外渗,7例术后出现高热(39℃),无血气胸、腹腔脏器损伤、肾切除等严重并发症。结论 B超引导下MPCNL具有创伤小、痛苦少、恢复快、住院时间短、结石取尽率高、并发症少等优点,是治疗上尿路结石的较好的微创方法。

Clinical analysis on B ultrasound-guided mini-percutaneous nephrolithotomy for upper urinary tract stones in 120 cases

Objective To investigate the method and therapeutic effect of B ultrasound-guided mini-percutaneous nephrolithotomy（MPCNL）in the treatment of upper urinary tract stones. Method One hundred and twenty cases of upper urinary tract were treated with B ultrasound-guided MPCNL, among them, 50 were renal staghorn and multiple stones, 38 were single pelvis and single calyceal stones, 18 were bilateral renal calculus, and 14 were upper ureteral calculi. Results Of all 120 patients, 118 were performed with MPCNL successfully ,among which, 95 （including 5 cases dual-path mPNL） were eradicated the stone in the first time, and 23 in the second time;and the other 2 were transformed to open surgery for kidney puncture. Nineteen of 120 cases with residual stone were prescribed with extracorporeal shock wave lithotripsy or the observational treatment, and the overall stone clearance rate was 82.5% （99/120）. The average operation time was （90±20 ）min, the average hospital stay was （10±2） day, the average nephrostomy tube retention time was （4±1） days, and the average retention time of double J tube was 4 weeks. Eight cases appeared bleeding during the postoperative week, among them, 3 cases needed transfusion, 5 cases developed urinary extravasation;and 7 cases had postoperative fever （＞39℃）. No other complication like hemopneumothorax, abdominal organ injury,or nephrectomy occurred. Conclusion B ultrasound-guided MPCNL is an excellent microinvasive method for upper urinary tract stone, with advantages of less trauma, less pain, quicker recovery, shorter hospital stay, high stone clearance, fewer complications, etc.