经皮肾穿刺取石术中影响肾结石一次清除率的原因

Factors influencing the clearance rate in percutaneous nephrolithotomy

目的:探讨在经皮肾穿刺取石术中影响肾结石一次清除率原因,并提出相应的对策。方法:在对435例肾结石患者行经皮肾穿刺取石术的不同的时间段,分别使用B超或X线引导、气压弹道或钬激光碎石、俯卧位或侧卧位等方法。结果:不同的时间段、结石和方法导致结石的一次清除率不一致,333例结石一次性清除,其余102例结石需再次经皮肾穿刺取石术或ESWL处理,但有43例拒绝再次治疗。结论:在经皮肾穿刺取石术中术者的经验和判断、肾结石的复杂性、肾穿刺部位的准确性、灌注液的外渗、肾出血等因素是影响肾结石一次清除率重要原因,应在术前应作好个性化方案;肾结石一次清除率对结石的总清除率有重要影响。

Objective： To analyze the factors that influence the first clearance rate in percutaneous nephrolithotomy. Methods：Totally 435 cases of patients receiving percutaneous nephrolithotomy were included in this study. Nephrolithotomy were carried out with ultrasound-guide or c-arm guide, holmium laser lithotripsy or pneumatic lithotripsy. Results：Stone clearance was obtained in 333 cases at first treatment, the remaining 102 cases need percutaneous nephrolithotomy again or ESWL, but 43 of them refused second treatment. Conclusions：Factors influencing the clearance rate includ the experience and sense of operator, complexity of calculi, veracity of tract position, bleeding and extravasation.