经皮肾微创输尿管镜治疗肾结石250例

Treatment of Renal Stones with Minimally Invasive Percutaneous Nephrolithotomy in 250 Cases

目的：探讨微创经皮肾穿刺输尿管镜碎石取石术（MPCNL）治疗肾结石的方法及疗效。方法：采用术前模拟手术俯卧位，在X线下进行体表标记定位及B超测算穿刺角度和深度的方法，引导穿刺行MPCNL术，对本院住院的250例接受该方法治疗的肾结石患者的临床资料进行回顾性分析。结果：250例中成功穿刺建立皮肾通道245例，5例仍需C臂X线引导穿刺。Ⅰ期取石175例，Ⅱ期取石术70例，Ⅲ期取石术5例，无中转开放手术，其中单通道取石187例，双通道取石48例，三通道取石15例。手术时间0．5～3．0h，平均（1．5±0．5）h。肾结石取净率87．4％，平均住院天数（10±2）d，术中无输血病例。结论：MPCNL术治疗肾结石操作简单，容易掌握，疗效好，可在基层医院推广。

Objective：To evaluate the efficacy of minimally invasive percutaneous nephrolithotomy （MPCNL） in treatment of renal stones. Methods： The MPCNL procedures were performed following guided puncture according to X- ray planning and B-mode ultrasound estimation of puncture angulation and depth completed beforehand with patients lying prone to simulate the position during surgery. Data of 250 patients receiving the procedure in our hospital were analyzed retrospectively. Results： In 245 out of 250 cases, approach to the renal stones was successfully established, with 5 needing guidance with C-arm X-ray. The renal stones were evacuated in 175 cases by one-stage procedure, in 70 by two-stage procedure and in 5 by three-stage procedure. No case required conversion to open surgery. Single channel was used in 187 cases, dual channel in 48 cases and triple channel in 15 cases. The duration of operation was 0.5 - 3.0 h at a mean of （1. 5 ±0.5 ） h. The total stone-free rate was 87.4% and mean hospital stay was （10 ± 2 ）days. None of the patients needed blood infusion during the procedure. Conclusions： MPCNL for renal stones seems to be an effective therapy which can be easily manipulated and learned as to be generalized in grass root hospitals.