经皮肾穿刺治疗肾结石276例临床分析

Percutaneous Nephroscopic Lithotripsy in Treatment of 276 Patients with Kidney Stones

目的探讨经皮肾穿刺治疗肾结石在临床中的应用价值.方法回顾性分析柳铁中心医院自2007年3月至2010年3月,采用经皮肾穿刺输尿管镜钬激光、气压弹道碎石治疗各种肾结石276例患者的临床资料,总结经验,评价其安全性和疗效.结果 276例,均一次性穿刺成功,行双通道穿刺6例,Ⅱ期手术24例.241例患者Ⅰ期成功取净结石,成功率达87.32%,其中24例残余结石较大或术中出血较多者,行Ⅱ期手术,获得成功,11例肾盂或中、上盏残余结石大于0.5 cm者,行体外冲击波碎石治疗,对小于0.5 cm者予口服排石药物治疗,术后1个月复查KUB及超声检查,结石均排净,积水均消失或减轻.手术时间(自穿刺开始)40～240 min,平均120 min,术中出血量估计30～400 mL,平均215 min,无术中输血病例,术后高热27例,血细菌培养阳性3例,抗炎治疗后痊愈.术后9～14 d继发大出血2例,经卧床、抗炎、止血、持续膀胱冲洗等治疗,出血停止,无其它严重并发症.结论采用经皮肾穿刺治疗肾结石具有创伤小、成功率高、出血少、并发症少等优点,治疗肾结石安全有效,较大结石联合应用钬激光和气压弹道碎石效果更佳.

Objective To explore the application of ercutaneous nephroscopic lithotripsy in treatment of kidney stones.Methods A retrospective study was conducted in 276 patients who accepted Percutaneous nephroscopic lithotripsy since March 2007 to March 2010,by ureteral mirror using holmium laser or air pressure ballistic gravel treatment of various kidney stones,the experience was summarized and its safety and efficacy were evaluated.Results All 276 patients had success in one-time puncture,6 patients were given double channel puncture and 24 patients underwent Ⅱperiod surgery.241 patients underwentⅠ period surgery,with the success rate of 87.32%,including 24 cases with larger residual stones or serious intraoperatie bleeding who were successfully treated by Ⅱ period surgery,11 cases of residual stones exceeding 0.5 cm in renal pelvis,medial or upper calices who accepted extracorporeal shock wave lithotripsy treatment,patients with residual stones less than 0.5 cm were orally given drug therapy.One month after percutaneous nephroscopic lithotripsy,the KUB and ultrasound were reexamined,and calculi disappeared in all cases,hydronephrosis was alleviated or disappeared.Operation time(since puncture started) was 40～240 min,and the average peri-operative time was 120 min.The blood loss was 30～400 mL,average 215 mL,and no intraoperatie blood transfusion cases.27 cases of postoperative high fever were found,and 3 cases of positive blood germiculturem who were cured after anti-inflammatory treatment.2 cases were found with postoperative 9～14 days secondary hemorrhage,and were cured by anti-inflammatory.hemostatic,continuous bladder douche treatment,no serious complications occurred.Conclusions Percutaneous nephroscopic lithotripsy for kidney stones has such advantages as minimal invasion,high success rate,less blood loss,and less complications,and is a safe and effective treatment for kidney stones.For big calculus,Percutaneous nephroscopic lithotripsy combined with holmium laser and pneumatic ballistic gravel has better effect.