经皮肾微造瘘通道肾镜治疗肾结石

Treatment of Nephrolithiasis with Micro-fistula Channel via Skin by Nephroscope

目的探讨经皮肾微造瘘通道肾镜治疗肾结石的方法和效果。方法回顾性分析了50例53侧肾结石采用PCNL治疗的患者资料。男32例,女18例。平均年龄41岁。左肾结石23例,右肾结石20例,双肾结石7例,其中3例行双侧治疗。53侧肾均建立了Fr 18或Fr 20的经皮肾通道,经肾镜行气压弹道及超声碎石清石术,合并输尿管结石的患者以输尿管镜进入,用EMS弹道碎石机将结石击碎并冲入肾内再行PC-NL治疗。结果51侧肾行Ⅰ期穿刺并同时碎石,2侧因出血改为Ⅰ期造瘘,Ⅱ期碎石,双侧肾结石同时治疗1例。单通道49侧肾,双通道4侧肾。其中,38例Ⅰ期碎石清石成功,12例需Ⅱ期手术碎石清石,3例通过Ⅲ期手术碎石清石。碎石清除率为86.5%。单侧肾平均手术时间为57.5 min。术中均未输血。治疗均获成功。结论经皮肾微造瘘通道肾镜治疗肾结石具有创伤小,出血少及并发症少的优点,提高了清石率,缩短了手术时间,对于治疗体积较大(直径>2.5 cm)或较硬的肾盂结石较MPCNL为佳。

Objective To discuss the method and effect of treatment of nephrolithiasis with micro - fistula channel via skin of nephroscope. Methods The PCNL materials of 50 in 53 cases of such patient were ana/yzed retrospectively. There were male 32 cases, female 18 cases with average age of 41. there were left 23 cases, fight 20 cases and bilateral 7 cases among 3 cases had treated same time. All the cases had performed with EMS and PCNL method. Results 51 sides stone cases were fmished in first stage. 2 cases had performed fistula and then crushed stone in second stage. 1 case had performed bilateral in same time. There were single channel of 49 cases and double channels of 4 case. The successful of crushed stone was 86.5 % with single average time 57.5rain and without blood perfusion. 38 cases had performed in first stage, 12 cases in second stage and 3 cases in third stage. Conclusion This method might have less injury, less bleeding, less complication so that to improve the successful rate, shorten operation time. The best indication might be big stone （more than 2.5cm in diameter） or hard stone treated with MPCNL.