标准通道经皮肾镜取石术治疗上尿路开放手术后肾结石

Standard tract percutaneous nephrolithotomy for renal calculi patients with open surgery history of kidney and upper ureter

目的评价24F标准通道经皮肾镜取石术（PCNL）治疗上尿路开放手术后肾结石的有效性和安全性。方法有上尿路开放手术史肾结石患者11例，平均年龄44岁。其中曾行肾实质或肾盂切开取石术5例、肾盂输尿管连接部成形术3例、上段输尿管切开取石术2例、肾部分切除术1例。左侧5例、右侧6例。结石单发2例、多发5例、鹿角状4例。结石体积1．7～47．1cm3。采用B超引导下穿刺，两步法建立24F标准通道，超声碎石、清石系统粉碎并清除结石。结果11例均成功建立通道并一期手术，其中单通道清除结石9例、双通道2例；经中组肾盏建立通道10例、经上盏2例、经下盏1例。平均手术时间（86．2±34．2）min，建立通道时间（14．1±11．0）min。一期手术结石清除率为91％（10／11）。11例围手术期均未发生严重并发症。结论B超引导下穿刺的24F标准通道PCNL治疗上尿路开放手术后肾结石安全有效。

Objective To evaluate the efficacy and morbidity of standard tract percutaneous nephrolithotomy （PCNL） for patients with open surgery history of kidney and upper ureter. Methods Eleven patients with open surgery history of kidney and upper ureter underwent standard tract （24 F） PCNL. Five patients had open nephrolithotomy, 3 had pyeloplasty, 2 had open ureterolithotomy and 1 had partial nephrectomy. Five calculi were in left kidney and 6 in right side. Two cases had single calculus, 5 had multiple, and 4 had staghorn calculi. The stone burden was 1.7--47.1 cm3. Results All patients were successfully operated in one-session procedure. Nine PCNLs were accomplished by single and 2 by double accesses. The mean operating time was 86.2±34.2 min, the mean first accessing time was 14.1±11.0 min. The stone-free rate after one session operation was 91% （10/11）. No complication occurred. Conclusion Standard tract PCNL for patients with open surgery history of kidney and upper ureter could be effective and safe.