经皮肾镜取石术处理肾结石

Treatment of renal calculi with percutaneous nephrolithotomy

目的探讨经皮肾镜取石术(PCNL)处理肾结石的方法与效果。方法回顾性分析118例采用PCNL治疗的肾结石患者资料。男86例,女32例。平均年龄39岁。其中单纯肾盂结石11例,单纯肾盏结石16例,肾盂和肾盏多发结石35例,肾铸形或鹿角形结石54例。双侧肾结石2例。结石大小2.0 cm×1.0 cm～4.5 cm×4.0 cm,平均2.5 cm×1.5 cm。结果112例患者一期取石,6例二期取石。单通道取石114例,双通道取石4例。1次取石60例,2次取石42例,3次取石16例。结石清除率81.4%(96/118),平均手术时间120 min,平均住院15 d。术中均未输血。1例术后4 d并发出血,出血量约500 ml,经输血、抗炎等保守治疗治愈,其余未见严重并发症。结论MPCNL具有创伤小、出血少及并发症少等优点,治疗肾结石安全有效,尤其对肾结石再次手术治疗有较大优越性。

Objective To evaluate the feasibility and efficacy of percutaneous nephrolithotomy （PCNL） in treating renal calculi. Methods The data of 118 patients with renal calculi who had undergone PCNL from July 2002 to August 2004 were retrospectively analyzed. There were 86 men and 32 women. The mean age was 39 years （range,7 -68 years）. Of the 118 cases ,11 had pelvic calculi,16 had calyx calculi,35 had pelvocalyceal calculi,54 had staghorn calculi,and 2 had bilateral renal calculi. The mean stone size was 2.5 cm x 1.5 cm （ranged from 2.0 cm × 1.0 cm to 4.5 cm ×4.0 cm）. Results Of the 118 cases, 112 underwent one-stage PCNL,and 6,two-stage PCNL. The procedure was performed by single tract in 114 cases,and by two tracts in 4 cases. Lithotomy was done by one session in 60 cases, by 2 sessions in 42 cases,and by 3 sessions in 16 cases. The total stone clearance rate was 81.4%. The mean operative time was 120 min,and mean hospital stay was 15 d. No blood transfusion was needed during operation,and only one patient experienced bleeding （ about 500 ml） after 4 d postoperatively, and was cured by conservative treatment such as blood transfusion and anti-inflammation. No major complications were observed in other patients. Conclusions PCNL has advantages of minimal trauma,less blood loss,fewer complications,and is safe and effective in treating renal calculi, especially for patients who will have the second procedure.