多通道微创经皮肾取石术治疗孤立肾肾结石

Treatment Of Solitary Kidney Calculi With Minimally Invasive Percutaneous Nephrolithotomy

目的探讨多通道微创经皮肾取石术(MPCNL)治疗孤立肾肾结石的安全性与有效性。方法经皮肾通道扩张至F14～F16,用小口径的输尿管硬镜(通常为F8/F9.8)替代肾镜,采用多通道取石,利用高压灌注泵的脉冲水压,冲出小碎石。结果38例患者中,5例先行经皮肾穿刺造瘘术,5～7d后行二期PCNL,其余33例患者均行一期取石。所有患者为1～3通道取石,结石清除27例(86%)。1例孤立肾肾结石合并积脓,行一期取石,术后出现中毒性休克,1例合并糖尿病患者术后出现酮症酸中毒,其余未发现严重并发症。结论采用多通道取石可以克服单通道难以取出平行于通道的盏石的缺点,提高结石清除率,减少术中出血,加快结石取出速度。

Objective:To assess the safety and feasibility of minim al ly invasive percutaneous nephrolithotomy(MPCNL)in treatment of solitary kidn ey calculi.Methods:The nephropathy was extended to F14-F16 through invasive pe rcutaneous.A small size of ureterscope(F8/F9.8)was used to take stones and the c rushed stones were pushed out by pulse water pressure.Results:Among 38 cases,5 w ere pretreated by percutaneous nephropancture and treated secondary PCNL.The res t 33 cases were treated with first PCNL.One to three tracts were used in all cases.There were 27 cases(86%)showed stone-free after treated with one-stag e minimally invasive percutaneous nephrolitho tomy.Only one case with pyonephr osis suffered from postoperative infect appeared shock while one-stage min imally invasive percutaneous nephrolithotomy.Another one with diabetes suffered from postoperative ketoacidosis,no major complications were noted in other p atients.Conclusion:Minimally invasive percutaneous nephrolithotomy is safe an d effective in treating solitary kidney calculi,compared to traditional PCNL.It may offer advantages with respect to less invasion and easy recovery.