彩超引导下经皮肾微造瘘通道输尿管镜钬激光治疗肾结石疗效观察

Efficacy of Minimally Invasive Percutaneous Nephrolithotomy with Holmium Laser under the Guide of Ultrasound in Treating Kidney Calculi

目的探讨彩超引导下经皮肾微造瘘通道输尿管镜治疗肾结石的临床疗效。方法回顾性分析71例彩超引导下经皮肾微造瘘通道输尿管镜下钬激光治疗肾结石患者的临床资料,探讨彩超引导通道建立优势及碎石疗效。结果 71例患者均建立理想的穿刺通道一期碎石,1次取净结石45例,占63%,1周后经通道或再次穿刺行经皮肾穿刺微造瘘取净结石19例,7例结石残留患者接受体外冲击波碎石(ESWL)治疗,两次手术结石总取净率为90%,手术时间平均95 m in,术中无一例输血,1例患者因左肾动静脉瘘继发出血行选择性肾动脉栓塞后痊愈,无一例术中转开放手术。结论彩超引导经皮肾通道穿刺的建立方法安全、简便,易于临床掌握。

Objective To evaluate the efficacy of minimally invasive percutaneous nephrolithotomy（MPCNL） under the guide of B Ultrasound in treating kidney calculi.Methods We retrospectively analysed the clinical data of 71 kidney calculi patients underwent MPCNL under the guide of B Ultrasound with the hope to explore the advantages of ultrasound in establishing renal channel for percutaneous nephrolithotomy（PNL） and the efficacy of the method in treating kidney calculi.Results Renal channels were established successfully in all 71 cases with first-time lithotripsy performed,through which 45（63%）cases were cured.Another 19 cases were cured by a second-time MPCNL either through the original renal channel or a second paracentesis.Still,7 cases with residual stones were cured by extracorporeal shock wave lithotripsy（ESWL）.Rate of complete stone clearance within the first two operations was 90%.The average operative duration was 95 minutes and not one case of blood transfusion was recorded.One case of secondary bleeding due to left renal arteriovenous fistula was cured by selective renal artery embolization.No cases of transfer to open operation was recorded.Conclusion MPCNL under the guide of B Ultrasound is a safe and effective method in treating kidney calculi which is both less invasive and easy to perform.