不同路径微创经皮肾取石术治疗肾上盏结石(附64例报告)

Minimally invasive percutaneous nephrolithotomy with different pathways in treatment of upper calyx calculi(report of 64 cases)

目的总结提高微创经皮肾取石术治疗肾上盏结石的水平。方法回顾性总结64例肾上盏结石患者接受微创经皮肾取石的手术路径、效果和主要并发症。结果肾中盏穿刺入路43例,结石清除率为88.4%;下盏穿刺入路7例,结石清除率为85.7%;上盏穿刺入路为14例,结石清除率为78.6%。1例第10肋间上盏穿刺入路患者,术后第6天拔除肾造瘘管后出现轻度液胸。无严重出血和需要输血病例。结论根据上盏结石的大小、形态、部位和肾脏集合系统的解剖情况,恰当地选择微创经皮肾取石的手术入路,可以提高疗效和减少并发症的发生。

Objective To summarize experience and improve the level of treating upper calyx calculi with minimally invasive percutaneous nephrolithotomy （MPCNL）. Methods 64 patients underwent minimally invasive percutaneous nephrolithotomy. The operative approach, effect and main complications were summarized retrospectivelly. Results 43 patients underwent middle calyx nephrostome,the stone-free rate being 88.4%; 7 patients lower calyx nephrostome,the stone- free rate being 85.7% ; 14 patients upper calyx nephrostome, the stone-free rate being 78.6% ; 1 patient with 10^th subocostal and upper calyx nephrostomy, suffered from light hydrothorax after the nephrostomy tube was pulled out on 6^th day postoperation. None of the patients suffered from severe haemorrhage or needed transfusion. Conclusion Chosing appropriate pathway of MPCNL according to the size, shape, site of the upper calyx calculi and the anatomy construction of kidney collecting system, can improve the efficacy and decrease complications.