210例无积水肾结石微创治疗的疗效观察

目的：探讨经皮肾微创治疗无积水肾结石患者的临床疗效。方法：回顾性分析2009年8月～2011年3月我院采用经皮肾镜取石术微创治疗210例无积水肾结石患者。改进人工肾积水的方法。行患侧输尿管逆行插入双J管，留置尿管，利用膀胱持续灌注通过双J逆流制造人下肾积水；超声联合X线引导下穿刺目标肾盏，建立经皮肾通道行微创经皮肾镜取石术。对手术时间、结石清除率、手术并发症等临床资料进行分析。结果：208例患者均1期穿刺成功，204例成功施行1期单通道取石，4例完全性鹿角型结石患者，阕结石较大，患者年龄较大，存在基础疾病，手术时间超过2h，改为2期手术取石；2例患者术中出血穿刺失败，中转开放手术。195例患者1期1次手术取净结石；3例患者2次经皮肾镜取石术取净结石；2例患者残留结石配合ESWI。加药物排石治疗，术后1～3个月复查无结石残留，总结石清除率95．2％（200／210）。手术时间60～130min，平均75min。3例患者术中出血较多，输血400～600ml。无气胸、周同脏器副损伤等严重并发症发生。结论：采用改进制造人工肾积水的方法，在超声联合X线引导下行微创经皮肾镜取石术，治疗无积水肾结石，具有穿刺成功率高、手术时间短、结石清除率高、手术并发症少等优点，是微创治疗无积水肾结石的首选方法。

The minimally invasive for treatment of renal calculi in non-dilated collecting system in 210 patients

Objective：To evaluate the efficacy and safety of minimally invasive percutaneous treatment of renal calculi in non-diIated collecting system. Method： A retrospective analysis from August 2009 to March 2011, Hebei University Hospital percutaneous nephrolithotomy stone surgery minimally invasive treatment of 210 cases of renal calculi in non dilated collecting system. Improved artificial hydronephrosis way line into the ipsilateral ureter retro grade double-J tube, indwelling catheter, bladder infusion through the use of double-J counter-current manufacturing artificial hydronephrosis; Under the guidance of ultrasound combined with X-ray target calyeeal puncture to es tablish percutaneous renal access line of minimally invasive percutaneous nephrolithotomy lithotomy. Clinical data including operation time, stone free rate, complications were analyzed retrospectively. Result：The percutaneous ra- nal access was successfully established in 208 patients, immediate phase I lithotripsy was performed in 204 cases and delayed phase II lithotripsy in 4 cases because of the larger stones, older patients, there is underlying disease, surgery for more than 2 h with complete staghorn stone type. 2 cases of patients with bleeding, so puncture failured, turn to open surgery. 195 cases of patients phase I lithotripsy operation removed in stones in one time. 3 patients secondary percutaneous nephrolithotomy lithotomy removed in stones; 2 patients with residual stones ES WE plus drugs row of stone treatment, after 1 to 3 months later without residual stones, the total stone-free rate amounted to 95.2%0. Operative time ranged from 60 to 130 minutes, an average time was 75 minutes, 3 patients were surpported by blood transfusion, severe complication did not occur during nephrolithotripsy. Conclusion： A modified method of manufacturing artificial hydronephrosis in the B-joint X-ray guided minimally invasive percutaneous nephrolithotomy stone surgery, treatment of kidney stones without water, with a puncture success rate, shorter operative time, stone free rate, surgery fewer complications, a minimally invasive treatment of kidney stones without water the preferred method.