彩超定位微造瘘一期经皮肾镜取石术治疗上尿路结石

Treatment of upper urinary calculi on minimally invasion first stage percutaneous nephrolithotomy with color ultrasonography guide

目的探讨彩超定位微造瘘一期经皮肾镜取石术治疗上尿路结石的优势和疗效。方法采用彩超定位微造瘘一期经皮肾镜取石术治疗上尿路结石30例,其中肾结石18例,输尿管上段结石12例。肾结石长径1.5～3.5cm,输尿管上段结石长径0.8～1.8cm。术中利用彩超定位,选定穿刺肾盏后常规彩色多普勒显示肾内血管,避免穿刺扩张时损伤肾段动脉及叶间动脉,降低术中、术后出血机率。结果30例均行一期取石术,其中一次取石25例,2次取石5例,单通道取石24例,双通道取石6例,结石清除率90%。手术时间1～3h,平均110min。术中有明显出血1例,经处理后出血减少,继续手术,未输血;无术后大出血及其他并发症。平均住院时间9d。结论彩超定位微造瘘一期经皮肾镜取石术是一种有效的治疗上尿路结石的方法,创伤小,出血少,恢复快。

Objective To evaluate the efficiency and advantages of treatment of upper urinary calculi on minimally Invasion first stage percutaneous nephrolithotomy with color ultrasonography guide.Methods Retrospectively investigated 30 patients with upper urinary calculi who were treated on minimally invasion first stage percutaneous nephrolithotomy with color ultrasonography guide,renal calculi is in 18 cases,upper uriteral calculi in 12 cases.Of 18 cases,the diameter of the stone is from 1.5 cm to 3.5 cm.of 12 cases with upper uritertal calculi,the diameter of the stone is from 0.8 cm to 1.8 cm.We selected stabbed renal calyx under color ultratary guided and renal vessels were also showed,the aim is to avoid damaging renal vessels and to reduce the happening rate of hemorrhage intraoperatively and postoperatively when stabbed and expanded.Results All cases were performed one-stage procedure,one session procedure in 25,two sessions in 5,single tract in 24,two tract in 6,respectively.The stone-free rate was 90%.The time of operation was 1-3 hours,average operative time was 110 minutes.Only 1 case suffered from ruassive hemorrhage intraoperativelly and bleeding reduced after deeling,the operaion was finished at last and no biood transfution happened.No obvious hemorrhage and other complications were observed postoperatively.The mean hospitalization time was 9 days.Conclusion The minimally invasive first stage percutaneous nephrolithotomy with color ultrasonography guide is an effective technique in upper urinary calculi treatment.The patients had less morbidity and quickly return to preoperative activity.