微创经皮肾穿刺取石术治疗上尿路结石

目的：探讨微创经皮肾穿刺取石术(PCNL)治疗上尿路结石的安全性及有效性。方法：对接受微创经皮肾取石术治疗的858例上尿路结石患者进行了回顾性分析。其中单发肾盂、肾盏结石213例，输尿管上段结石111例，手术后残留结石129例，肾铸型或鹿角形结石391例；双侧肾结石14例。结果：所有患者均行一期穿刺取石，共行1015次手术。其中单通道穿刺取石672侧肾，二通道186侧肾，三通道13侧肾，四通道1侧肾，结石清除率90．18％，平均手术时间98min，肾造瘘管留置时间平均6d，平均住院14d，其中2例需要输血，仅1例术后10d并发大出血，经高选择性肾动脉栓塞止血治愈，其余未出现大的并发症。结论：微创经皮肾取石术治疗上尿路结石是有效的。它与开放手术及传统经皮肾取石术相比，能减少术中、术后出血及并发症，明显提高结石的清除率，具有对患者创伤小、恢复快、缩短住院时间等优点，并对残留结石和复发结石的再次手术治疗有较大优越性。

Treatment of upper urinary calculi on minimally invasive percutaneous nephrolithotomy (Experience of 858 cases for 1 015 mPCNL)

Purpose:To assess the safety, feasibility and superiority of minimally invasive percutaneous nephrolithotomy(mPCNL) in treating upper urinary calculi. Methods:We retrospectively investigated 858 patients suffering from renal calculi and upper ureteral calculi, who were treated with minimally invasive percutaneous nephrolithotomy from March 2000 to December 2002. Of 858 cases, pelvocalyceal calculi was in 213 cases, upper ureteral calculi in 111 cases, postoperative residual stone in 129 , staghorn calculi in 391, bilateral renal calculi in 14, respectively. Results:Of 858 cases, 90.18% stone free rate was achieved using one stage minimally invasive percutaneous nephrolithotomy. They were treated by 1015 mPCN, Single tract was in 672 renal units, two tracts in 186 renal units, three tracts in 13 renal units, four tracts in 1 renal unit, respectively. Average operative time was 98 munites, average nephrostomy tube stay was 6 days, average hospitalization stay was 14 days. Blood transfusion was performed in 2 patients, Only one case suffered from massive hemorrhage postoperative 10 day, who was cured by selective embolism of renal artery , no major complications were noted in the other patients. Conclusions:Minimally invasive percutaneous nephrolithotomy is safe and effective in treating upper urinary calculi, Compared to open surgery and traditional PCNL,it may offer advantages with respect to less introoperative and postoperative complications , high stone free rate, less invasion, easy recovery and short hospitalization stay. It also has an advantages of treating the patients with residual and recurrent calculi.