B超引导下微创经皮肾镜取石术的临床研究

Minimally invasive percutaneous nephrolithotomy in treatment of renal calculi under ultrosound guid-ance

目的探讨B超引导下微创经皮肾镜取石术治疗肾结石的优势及临床效果。方法2007年5月至2011年4月采用B超引导下微创经皮肾镜取石术治疗肾结石187例，肾结石长径2．0～5．5cm，平均2．8cm，B超引导下选取肾盏穿刺，扩张经皮肾通道至F16，行经皮输尿管镜下气压弹道碎石术。结果187例均一期成功建立经皮肾通道并碎石。单通道取石165例（88．2％），双通道取石22例（11．8％），一期结石清除率为83．4％（156／187）。二期取石21例（11．2％），辅助体外冲击波碎石治疗10例（5．3％）。手术时间60—150min，平均110min。术后发热7例（3．7％）。无血气胸及腹腔脏器损伤，住院天数7～12d，平均10d。结论B超引导下微创经皮肾镜取石术治疗肾结石具有定位准确、工作通道建立安全、简便，创伤小，并发症少，出血少，结石清除率高等优点，是一种安全有效的方法。

Objective To study the advantage and clinical effect of minimally invasive percuta- neous nephrolithotomy （MPCNL） in treatment of renal calculi under uhrosound guidance. Methods From May 2007 to April 2011,187cases of renal calculi underwent MPCNL under ultrosound guidance. The stone measured from 2.0 to 5.5 cm （ average ：2.8 cm） in length. After channel were dilated to F16, MPCNL were performed under F8/9.8 Ureteroscope. Clinical data including operation time, complica- tions and stone free rate were analyzed retrospectively. Results All the operations were completed in one session,single tract was used in 165 cases（88.2% ） ,double tracts were used in the other 22 cases （ 11.8% ）, the stone free rate after one session was 83.4% （156/187） ,21 cases （ 11.2% ） received a second-session MPCNL, 10 cases （5.3%）underwent ESWL after operation, the mean operating time was 110 rain （ range from 60 to 150 rain）. Postoperative surgery-related infection rate was 3.7 % （7/187 ）. No pleural or important organ injury occurred. Hospital stay was 7 -12 d,with a mean of 10 d. Conclusions Minimally invasive percutaneous nephrolithotomy under ultrosound guidance in treatment of renal calculi has less bleeding, high clearance rate, minimally invasion, less complications, short hospital stay, and is a highly efficient and safe technique.