微创经皮肾镜取石术治疗肾脏鹿角状结石128例分析

目的探讨微创经皮肾镜取石术治疗肾脏鹿角状结石的有效性和安全性。方法2002年4月至2006年12月应用微创经皮肾造瘘,输尿管镜下气压弹道碎石或钬激光碎石治疗128例肾脏鹿角状结石,统计分析手术时间、结石清除率和手术并发症。结果部分鹿角状结石52例,完全鹿角状结石76例;共行147例次取石,单通道取石118例(92.2%),双通道10例(7.8%);Ⅰ期取石109例(85.1%),Ⅱ期取石19例(14.9%);平均手术时间120 m in;Ⅰ期取净结石者住院5~8 d,平均6.4 d;112例结石取净,总结石取净率87.5%;经皮肾通道扩张后大出血1例,术后感染12例,感染性休克2例;2例术后出血严重,经输血及超选择性肾动脉栓塞后治愈。结论微创经皮肾镜取石损伤小,术中出血及并发症少,结石清除率高,可重复取石,是治疗肾脏鹿角状结石有效的微创手段。

Clinical analysis of minimally invasive percutaneous nephrolithotomy in treatment of 128 patients with staghorn stone

Objective To evaluate the efficacy and safty of minimally invasive percutaneous nephrolithotomy(M-PCNL) in the treatment of staghorn stone. Methods From April 2002 to December 2006,128 cases of staghorn stone were performed M-PCNL,and the clinical data of operation time,stone clearance rate and operative complications were retrospectively analysed. Results Among the 128 cases,52 were partial staghorn renal stone and 76 complete staghorn stone.One-stage operation was performed in 109 cases(85.1%),two-stage in 19(14.9%),and single channel was used in 118 cases(92.2%),and two channel in 10(7.8%).The mean operation time was 120 min.The duration of hospitalization was 5 to 8 d with an average of 6.4 d in patients with one-stage stone-free clearance.Complete stone clearance was achieved in 112 renal units,giving an overall clearance rate of 87.5%.Hemorrhea was occurred in one patient during the operation,and postoperative infection and septic shock were observed in 12 and 2 patients,respectively.Two patients complicated with severe bleeding after operation were successfully treated with blood transfusion and super-selective arterial embolization.Conclusion M-PCNL has definite efficacy in the treatment of staghorn stone with less invasion,bleeding and complications,as well as higher clearance rate.