手术治疗肾结石350例临床分析

目的总结分析经皮肾造瘘治疗肾结石的经验和教训,提高结石的治疗水平。方法 350例次肾结石在B超引导下,行患侧穿刺,见有尿液回流后依次扩张形成造瘘通道,置入输尿管镜或肾镜,找到结石,应用钬激光或气压弹道＋超声吸引进行碎石、清石,治疗结束后置双J管和引流管,1周后复查,如发现有残余结石可再次清石或经体外碎石治疗。结果 335例患者,行350例次手术,患侧一次结石清除率为65.4%（229/350）,经再次碎石、清石或体外碎石后,332例次治愈,约占94.9%（332/350）。术后并发症：发热39例次（占11.2%）;气胸1例,术后严重出血2例,经栓塞治疗后痊愈。结论经皮肾造瘘治疗肾结石效果好、并发症少。经多次应用后明显提高结石的清除率。

Clinical analysis on the treatment of renal calculus in 350 cases

Objective To analyze the experience and lessons of the treatment of renal calculus by percutaneous nephrostomy （PCNL） and improve the technical level. Methods 350 cases with renal calculus were treated with affected side puncture under the B-ultrasonic guiding; the cystostomy channel was made after urine backflow occurred and the ureteroscope or nephroscope was placed. Patients received holmium laser or TUPL combined with CUSA treatment; Double J tube and drainage tube were placed after treatment ends and rechecked after a week. Results 350 times operations were performed in 350 cases, the first clearance rate was about 65.4% （229/350）. After re-treat, 332 cases were cured; the cure rate was about 94.9% （332/350）. Complications ： there were 39 cases with fever （ about 11.2% ） , 1 case with pneumothorax, 2 cases with haemorrhage and treated by embolotherapy. Conclusion PCNL is an effective and safe treatment for the patients with renal calculus and can be applied several times to improve the clearance rate.