微创经皮肾镜取石术治疗复杂性肾结石

目的探讨微创经皮肾镜取石术治疗复杂性肾结石的方法及效果.方法 回顾性分析167例(共194肾)复杂性肾结石患者诊疗资料:肾盂肾盏多发结石96例(共113肾),结石最长径2.8cm(2.0～4.6cm);肾铸形或鹿角形结石71例(共81肾),结石最长径5.8cm(4.1～8.4cm).采用微创经皮肾镜取石术,碎石方法为联合应用钬激光和气压弹道碎石.结果 建立经皮肾通道211条,从穿刺到建立第一条通道时间平均6min;X线透视平均时间为52s;其中10例二次取石;单通道取石177侧患肾,双通道取石17侧患肾.结石清除率84.02%(163/194),平均手术时间85min,平均住院时间12d;术后平均血红蛋白下降12.8g/L,其中6例输血,2例延迟出血,1例经输血、抗炎等保守治疗治愈,1例行肾动脉选择性栓塞,脓毒血症2例经加强抗感染、对症治疗后治愈,无周围脏器损伤等严重并发症.结论 微创经皮肾镜取石术疗效确切,具有高效、安全、并发症少等优点,是治疗复杂性肾结石的有效办法.

Clinical study on mini-percutaneous nephrolithotomy(MPCNL) for the treatment of complex renal calculi

Objective To study the method and efficiency of mini -percutaneous nephrolithotomy（MPCNL） for the treatment of complex renal calculi. Methods The clinical data of 167 patients with complex renal calculi were treated under MPCNL with holmium：YAG laser lithotripsy and pneumatic lithotripsy was analysed retrospectively, including 140 patients with unilateral calculi and 27 patients with bilateral calculi, multiple pelvicalyceal renal calculi in 96 patients of 113 kidneys with calculi, the mean longitudinal size of calculi was 2. 8cm（2.0 -4. 6cm）, staghorn calculi in 71 patients of 81 kidneys with calculi, the mean longitudinal size of calculi was 5.8cm（4. 1 - 8.4era）. Results 211 punctures were built in 194 kidneys with calculi, the mean time for punctures was 6 rain, the mean time of exposure to X- ray was 52s. All cases underwent one- stage MPCNL, Ten cases demanded the second operation. The percutaneous renal accesses were successfully established under X - ray guide in all patients and two accesses were successfully established in the same kidney of 17 cases. The stone clearance rate was 84. 02% （163/194） , the average time for whole surgery was 85 minutes, the mean hospital day was 12. The mean hemoglobin drop was 12. 8g/L, six patients had blood transfusion, two patients had delayed hemorrhage： one was cured by blood transfusion and antibiotics, the other was treated with interventional embolization. Two patients had Pyemia, they were cured by reinforced anti - infection, there were no severe complications, such as injury of the surrounding organs. Conclusion It is effective and safe to treat the lithotripsy of combined holmium：YAG laser lithotripsy and pneumatic lithotripsy in MPCNL in complex renal calculi.