人工肾积水穿刺肾造瘘在治疗复杂性肾结石中的应用

Application of artificial hydronephrosis in percutaneous nephrostomy for the tre atment of complicated nephrolithiasis

目的探讨经皮穿刺肾造瘘术中建立人工肾积水在无积水复杂性肾结石治疗中的价值.方法对26例复杂性肾结石患者建立人工肾积水后于B超引导下行经皮肾穿刺造瘘取石术.男18例,女8例.年龄19～67岁,平均39岁.左侧12例,右侧10例,双侧4例.单发鹿角状结石8例,多发结石18例.结石长径3.0～6.5 cm,平均3.8 cm.逆行输尿管插管并通过此管向肾盂注入生理盐水形成人工肾积水,在B超引导下行肾盂穿刺,建立经皮肾盂通道.结果24例(92%)穿刺成功,2例失败改为经X线下肾盂造影定位穿刺成功.放置造瘘管28侧(93%).术中出血40～1200 ml,输血6例.结论对于无肾盂积水的复杂性肾结石,建立人工肾积水后在B超引导下穿刺肾盂造瘘,经皮肾盂穿刺成功率较高,是解决无积水肾微创手术的有效方法.

Objective To evaluate the value of artificial hydronephrosis in percutaneous nephrostomy for the treatment of complicated nephrolithiasis without hydronephrosis. Methods Artificial hydronephrosis was performed in 26 patients with complicated nephrolithiasis （18 men and 8 women; mean age, 39 years; age range, 19-67 years）. Among them the calculi were located on the left side in 12 cases, on the right in 10 and on both in 4; single staghorn calculus in 8 cases and multiple in 18. The mean diameter of the calculi was 3.8 cm （range, 3.0-6.5 cm）. Retro-ureteral cannulation was performed and normal saline was pumped into the pelvis and then artificial hydronephrosis was formed. And guided by B-ultrasound, minimally invasive percutaneous nephrolithotomy （MPCNL） was carried out. Results The procedure was successful in 24 （92.3%） of the 26 cases and failed in 2. Guided by X-ray of pyelographic location, puncture was performed and succeeded in the 2 cases. Catheters for fistulization were placed on 28 sides （93.3%） of the patients. Intraoperative bleeding was 40-1200 ml. Six patients received blood transfusion. Conclusions Percutaneous nephrostomy guided by B-ultrasound after artificial hydronephrosis is an effective method for patients with complicated nephrolithiasis without hydronephrosis.