微创经皮肾镜取石术治疗肾下盏结石

Treatment of renal lower caliceal calculi with minimally invasive percutaneous nephrolithotomy

目的探讨微创经皮肾镜取石术治疗有症状肾下盏结石的临床疗效。方法回顾性分析2001年3月至2005年4月采用微创经皮肾镜取石术治疗有症状的肾下盏结石患者33例,结石直径平均2.8 cm。33例均为单通道取石,10例为中盏通道,23例为下盏通道；14F通道9例,16F通道24例。结果33例患者中,一期结石清除率为85%(28/33)；3例因术中出血,留置肾造瘘管后改二期取石；1例残留结石者辅以ESWL治愈,1例残留结石＜4 mm者未处理。平均手术时间93 min,术中平均出血量113 ml,平均住院11 d。1例肝硬化患者术中输血200 ml。1例患者术后7 d出现迟发性大出血,采用高选择性肾动脉明胶海绵栓塞治愈。19例患者随访2～48个月,未见肾结石复发。结论微创经皮肾镜取石术治疗肾下盏结石安全、微创,恢复快。

Objective To investigate the clinical outcomes of minimally invasive percutaneous nephrolithotomy （MPCNL） in the treatment of lower ealiceal calculi. Methods We retrospectively reviewed the clinical outcomes and complications of 33 patients who underwent MPCNL for lower caliceal calculi from March 2001 to April 2005. The average diameter of the calculi was 2.8 cm. Single tract nephrostomy was performed in all 33 cases;among them renal access was obtained through a middle calyx in 10 cases and a lower calyx in 23. Nine eases had F14 renal access;and 24 cases,F16. Results Of 33 cases, 28 （85%） achieved stone-free at 1 session. A second-look was needed in 3 cases due to intraoperative bleeding;ESWL,in 1 case with residual calculi;no treatment,in 1 case with residual calculi 〈 4 mm. The mean operative time was 93 min ;mean blood loss was 113 ml;mean hospital stay was 11 d. Blood transfusion was needed in 1 patient who suffered from hepatic cirrhosis preoperatively;another experienced severe bleeding 7 d after operation and was cured with hyperselective spongia gelatinosa embolization of the renal artery. Follow-up was available in 19 cases for 2 - 48 months,and no recurrence of renal calculi was noted. Conclusions Minimally invasive percutaneous nephrolithotomy has advantages of safety,less invasion,and easy recovery for the treatment of lower caliceal calculi.