经皮肾镜钬激光碎石取石术治疗上尿路结石412例

目的探讨经皮肾镜钬激光碎石取石术（PCNL）治疗上尿路结石的疗效及作用。方法对从2004年10月～2009年10月应用PCNL技术治疗上尿路结石412例进行分析。患侧逆行置管后,在C臂X光引导（77例）或B超引导下（335例）进行穿刺,以筋膜扩张器递增扩张建立18～26 F皮肾操作通道,以输尿管硬镜或肾镜用钬激光碎石机将结石击碎、取出,常规留置肾造瘘管。结果 412例中有391例（94.9%）一期碎石及取石,21例（5.1%）行二期碎石或取石。其中单通道取石392例（95.1%）,双通道取石20例（4.9%）。平均结石清除率87.7%,平均手术时间130 min,肾造瘘管平均留置5 d,平均术后住院时间6.5 d。结论 PCNL治疗上尿路结石安全、高效,具有对患者创伤小、恢复快、结石清除率高等优点,是治疗上尿路结石的安全有效的方法之一。

Percutaneous nephrolithotomy with holmium laser for upper urinary calculi (Experience of 412 cases)

Aim To assess the efficacy and safety of the holmium laser with percutaneous nephrolithotomy for upper urinary calculi.Methods A restrospective investigation was made on 412 cases with upper urinary calculi,who were treated with percutaneous nephrolithotomy with the holmium laser from October 2004 to October 2009.After retrograde placement of the ureteral catheter,a track from the skin surface into the renal calyx was established under the guidance of X-Ray(77 cases) and B-type ultrasonography(335 cases).After dilation,the sheath from 18F to 26F was passed in,and then,rigid ureteroscopy or nephroscopy was passed to introduce a holmium laser lithotriptor.Stones were broken up and a nephrostomy tube was placed in the incision to carry fluid from the kidney.Results Holmium laser percutaneous nephrolithotomy was completed in the first stage of treatment in the 391 cases,and was achieved in the second stage of treatment in 21 cases.In 412 cases,392 cases were treated by single-tract nephrolithotomy and 20 cases were treated by double-tract nephrolithotomy.The stone-free rate was 87.7%.The average operation time was 130 min.The nephrostomy tube was left for 5 days.The length of postoperative hospital stay was 6.5 days.Conclusion Holmium laser percutaneous nephrolithotomy is safe and effective in the treatment of upper urinary calculi.