B超引导下微创经皮肾镜碎石术治疗复杂性肾结石

Treatment of complex renal calculi with minimally invasive percutaneous nephrolithotomy under guide of B ultrasound

目的评价B超引导下微创经皮肾镜碎石术治疗复杂性肾结石的疗效。方法在2004年7月～2008年12月,96例复杂性肾结石(包括33例肾鹿角型结石,39例肾多发性结石和24例肾结石并输尿管上段结石)在B超引导下行微创经皮肾镜碎石术,平均年龄46.8岁,18例曾行肾切开取石术,36例曾行体外震波碎石术。结果90例为经中盏单通道取石,6例为双通道取石,一期结石清除率为83.3%(80/96)。7例残余结石者辅助ESWL治疗,9例残余结石者需二次微创经皮肾镜碎石术。1例患者术后7d出现迟发性大出血,经选择性或超选择性肾动脉栓塞止血,肾功能恢复尚可。2例患者术后出现气胸,经B超定位下穿刺抽吸胸腔内积气后治愈。结论B超引导下微创经皮肾镜术治疗复杂性肾结石具有安全、有效和创伤小等优点。

[Objective] To evaluate the effect of minimally invasive pereutaneous nephrolithotomy（MPCNL） under guide of B ultrasound for complex renal calculi. [Methods] From July 2004 to Dec 2008, MPCNL under the guide of B ultrasound was operated on 96 eases of complex renal calculi, including 33 cases of renal staghom calculi, 39 multiple renal calculi, and 24 renal and upper ureteral calculi. The average age was 46.8 years （varied from 21 to 72 years）. Among them, 18 cases had open nephrolithotomy previously and 36 cases were treated with extraeorporeal shock wave lithotripsy （ESWL） before. [Results] Single tract nephrostomy was performed in 90 cases through a middle calyx,double tract nephrostomy in 6 cases. The stone-free rate was 83.3% （80/96） at one session. Seven cases required ESWL and nine cases with residual stones required one more MPCNL One patient with severe hemorrhage that occurred 7 day after MPCNL was successfully treated by selective or superselective embolization. Two cases developed pneumothorax and cured successfully by suction under B ultrasound guidance. [ Conclusions ] MPCNL under the guidance of B ultrasound has advantages of safety, efficacy and little invasion for the treatment of complex renal calculi.