微创经皮肾取石术(附92例报告)

Treatment of upper urinary calculi with minimally invasive percutaneous nephrolithotomy (report of 92 cases)

目的探讨微创经皮肾取石术治疗上尿路结石的疗效。方法从2000年1月至2004年11月期间采用微创经皮肾取石术共治疗92例上尿路结石病人,其中单发肾盂结石47例(51%),多发性结石37例(40%),输尿管上段结石8例(9%),有开放手术史11例。结果一期穿刺取石86例(95%),一期造瘘、二期取石5例(5%)。单通道取石79例,多通道取石13例。12例术后复查KUB仍有残石,结石清除率87%。手术时间平均140 min,术中、术后有明显出血6例(6.5%),均经保守治疗治愈,平均住院时间9 d。结论微创经皮肾取石术治疗上尿路结石安全、有效的方法,对病人创伤小,术后恢复时间短。

Objective To evaluate the efficiency of minimally invasive percutaneous nephrolithotomy （MPCNL） in treating upper urinary calculi. Methods From January 2000 to November 2004, 92 MPCNL procedures for upper urinary calculi were performed in our hosPital, with sole pelvic calculus in 47 patients, multiple calculi in 37, and impacted proximal ureteral caluci in 8, respectively. Among them, 11 cases had open nephrolithotomy history. Results Of the 92 cases, one- stage procedure was performed in 86 cases, and two-stage procedure performed in 5 cases. Single-access puncture was performed in 79 cases, and multi-accesses puncture in 13, respectively. Residual calculi were confirmed by X-ray postoperatively in 12 cases, the stone-free rate being 87%. Average operative time was 140 minutes. Only 6 cases suffered from massive hemorrhage during or after procedure and were successfully managed conservatively. The mean hospitalization time was 9 days. Conclusion MPCNL is an effective technique in treating upper urinary calculi. The patients have less morbidity and shorter recovery time.