微造瘘经皮肾输尿管镜取石术治疗上尿路结石216例临床应用

Experience of Minimally Invasive Percutaneous Nephrolithotomy for the Treatment of 216 Cases Upper Urinary Tract Calculus

目的探讨微造瘘经皮肾输尿管镜取石术(MPCNL)治疗上尿路结石的疗效。方法从2002年5月～2007年10月应用MPCNL技术治疗上尿路结石患者216例,首先造成患侧肾脏的人工肾积水,建立经皮肾通道(F16～18),其中建立单通道取石202例,双通道取石14例,在输尿管镜下使用气压弹道、钬激光碎石。结果216例中有183例均行Ⅰ期取石;33例行Ⅱ期取石;术中、术后有明显出血9例,约占4%,1例术后不可控制出血介入治疗失败行患肾切除术,余均经对症治疗出血停止,2例术后出现尿外渗,经调整肾造瘘管位置后治愈。平均结石清除率90.32%,平均手术时间79min,估计术中平均出血量约80ml,术后平均住院8天,肾造瘘管平均留置时间7.5天。结论微造瘘经皮肾输尿管镜取石术治疗上尿路结石安全、有效,对患者创伤小、恢复快、结石清除率高,疗效满意。

Objective To investigate effectiveness of treatment of Upper urinary tract calculus by MPCNL application. Methods From May 2000 to May 2007, causing artificial kidney hydronephrosis for the affected kidney, established renal percutaneous channels （ F16 - 18） , which established the single channels of 202 cases, dual - channel of 14 cases, by Ureteroscopic Lithotripsy and holmium laser lithotripsy. Results 183 cases of 216 patients were One - time stone; 33 cases were second stone. The average clearance rate is 90. 32% ,the average operation time is 79min, average valume of about bleeding is 80ml, the average hospitalization days are 8 days, kidney ostomy average stay 7.5 days. Of the operation, 9 cases of obviously bleeding （4%） before and after operation, 1 case uncontrollable bleeding after interventional treatment failure with Nephrectomy, others to stop beeding by symptomatic treatment, 2 cases find urinary extravasation postoperative and cured by adjusting location of renal ostomy. Conclusion Minimally invasive percutaneous nephrolithotomy for the treatment of Upper urinary tract calculus is safe and effective for patients with less trauma, quicker recovery and high learance rate, the efficacy is satifactory.