摘要
目的 :探讨微创经皮肾穿刺取石术 (PCNL)治疗上尿路结石的安全性及有效性。方法 :对接受微创经皮肾取石术治疗的 85 8例上尿路结石患者进行了回顾性分析。其中单发肾盂、肾盏结石 2 13例 ,输尿管上段结石 111例 ,手术后残留结石 12 9例 ,肾铸型或鹿角形结石 391例 ;双侧肾结石 14例。结果 :所有患者均行一期穿刺取石 ,共行 10 15次手术。其中单通道穿刺取石 6 72侧肾 ,二通道 186侧肾 ,三通道 13侧肾 ,四通道 1侧肾 ,结石清除率 90 .18% ,平均手术时间 98min ,肾造瘘管留置时间平均 6d ,平均住院 14d ,其中 2例需要输血 ,仅 1例术后 10d并发大出血 ,经高选择性肾动脉栓塞止血治愈 ,其余未出现大的并发症。结论 :微创经皮肾取石术治疗上尿路结石是有效的。它与开放手术及传统经皮肾取石术相比 ,能减少术中、术后出血及并发症 ,明显提高结石的清除率 ,具有对患者创伤小、恢复快、缩短住院时间等优点 ,并对残留结石和复发结石的再次手术治疗有较大优越性。
Purpose:To assess the safety, feasibility and superiority of minimally invasive percutaneous nephrolithotomy(mPCNL) in treating upper urinary calculi. Methods:We retrospectively investigated 858 patients suffering from renal calculi and upper ureteral calculi, who were treated with minimally invasive percutaneous nephrolithotomy from March 2000 to December 2002. Of 858 cases, pelvocalyceal calculi was in 213 cases, upper ureteral calculi in 111 cases, postoperative residual stone in 129 , staghorn calculi in 391, bilateral renal calculi in 14, respectively. Results:Of 858 cases, 90.18% stone free rate was achieved using one stage minimally invasive percutaneous nephrolithotomy. They were treated by 1015 mPCN, Single tract was in 672 renal units, two tracts in 186 renal units, three tracts in 13 renal units, four tracts in 1 renal unit, respectively. Average operative time was 98 munites, average nephrostomy tube stay was 6 days, average hospitalization stay was 14 days. Blood transfusion was performed in 2 patients, Only one case suffered from massive hemorrhage postoperative 10 day, who was cured by selective embolism of renal artery , no major complications were noted in the other patients. Conclusions:Minimally invasive percutaneous nephrolithotomy is safe and effective in treating upper urinary calculi, Compared to open surgery and traditional PCNL,it may offer advantages with respect to less introoperative and postoperative complications , high stone free rate, less invasion, easy recovery and short hospitalization stay. It also has an advantages of treating the patients with residual and recurrent calculi.
出处
《临床泌尿外科杂志》
2003年第9期516-518,共3页
Journal of Clinical Urology
