微创肾镜碎石取石术治疗开放手术后肾结石临床探讨

目的探讨微创经皮肾镜碎石取石术（MPCNL）治疗开放手术后肾结石的疗效和安全性。方法用微创经皮。肾镜碎石取石术治疗23例肾结石患者行开放手术后的残留结石及复发结石，观察结石的取净率、手术时间、术中术后出血量及并发症等情况。结果23例患者均成功穿刺建立经皮肾碎石取石通道，单通道取石16例，双通道取石6例，三通道取石1例。手术平均时间106min。平均术中出血170ml。2例术中出血至视野不清给予放置肾造瘘管，7d后行二期经皮肾镜手术。术后2例出现延迟性出血。术后4例出现发热，一期手术结石取净率73．9％（17／23）。2例行二期手术，结石总取净率82．6％（19／23）。平均住院时间8．65d，所有患者均无严重并发症发生。结论MPCNL是治疗肾结石行开放手术后残留结石及复发结石的有安全的手术方法。

Minimally invasive percutaneous nephrolithotomy for renal calculi patients with open surgery history stone

Objective To explore the efficiency and safety of minimally invasive percutaneous nephrolithotomy（MPCNL） for renal calculi patients with open surgery history stone. Methods Twenty - three patients with residual or recurrent re-nal stones after open surgery were treated by MPCNL. The stone clearance rate, operative time, intraoperative blood loss and complications were observed. Results All cases were treated successfully in one - session procedure, and 16 MPC-NL of these cases were accomplished by single channel,6 cases by double channels and 1 case by three channels. The average operation time was 106 minutes. The average intraoperative blood loss was 172ml. Two patients were given placed renal fistula because of bleeding ledding to the visual field and were treated by second stage MPCNL after 7 days. The postoperative complications were 2 cases of delayed hemorrhage and 4 cases of postoperative fever. The stone clearance rate were 73.9% （ 17/23 ） by one - stage MPCNL,and 2 cases had a second - stage MPCNL and the clearance reached 82. 6% （ 19/23 ）. The average hospitalization time is 8.65d, there were no serious complications occurred. Conclusion-s MPCNL is an effective and safety surgical method for renal calculi patients with open surgery history stone.