B超引导下微创经皮肾镜取石术治疗肾下盏结石(附26例报告)

Treatment of lower renal caliceal calculi by minimally invasive percutaneous nephrolithotomy guided by ultrasound(report of 26 cases)

目的探讨B超引导下微创经皮肾镜取石术(MPCNL)治疗肾下盏结石的可行性和安全性。方法2004年12月～2006年7月在B超定位引导下建立通道并同期行微创经皮肾镜取石术治疗肾下盏结石26例,26例均为16F单通道取石。9例为肾中盏通道,17例为肾下盏通道。结果25例1次准确穿刺目标肾盏并建立通道,1例因工作鞘脱出需2次手术重新穿刺建立通道,1次碎石成功21例,4例需2次碎石,结石清除率92%(24/26)。2例残留结石经体外冲击波碎石治疗治愈。平均手术时间51min,平均出血量63mL,未发生经皮肾镜取石术常见严重并发症。结论B超引导下微创经皮肾镜取石术治疗肾下盏结石安全、简便、效果理想。

[Objective] To investigate the efficiency and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） guided by ultrasound for the treatment of lower renal caliceal calculi. [Methods] Twenty-six patients who underwent MPCNL for lower caliceal calculi from December 2004 to July 2006 were reviewed retrospectively. 16F renal access and single tract nephrostomy were performed in all 26 cases. Renal access was obtained through a middle calyx in 9 cases and a lower calyx in 17. [Results] It was successful for 18 cases in the first time for kidney fistula. Only 1 case needed second time for performing the fistula. Of 26 cases, 21 achieved stone-flee in 1 session and 4 cases needed a second treatment. The rate of stone-free was 92%. 2 cases with residual calculi were treated by ESWL. The mean operative time was 51 min and mean blood loss was 63 mL. No serious complictions were observed. [Conclusions] MPCNL under ultrasound is a simple, safe and efficient method for the treatment of lower caliceal calculi.