B超引导下微创经皮肾穿刺钬激光碎石术治疗上尿路结石87例报告

B-ultrasonography Guided Minimally Invasive Percutaneous Nephrolithotomy with Holmium:YAG Laser for Upper Urinary Tract Stones:Report of 87 Cases

目的探讨微创经皮肾穿刺钬激光碎石治疗上尿路结石的有效性和安全性。方法患侧输尿管置入输尿管导管,B超引导下建立经皮肾通道,输尿管镜直视下置入钬激光光纤将结石粉碎,利用灌洗泵将碎石冲出体外。结果微创经皮肾穿刺钬激光碎石成功率为88.5%(77/87),手术时间35～190min,平均85min。9例肾盏内残余结石(>4mm)配合体外冲击波碎石及口服排石药,均成功排净残余结石。治疗成功率为97.7%(86/87)。术后住院4～16d,平均6.3d。1例术后严重出血,超选择性肾小血管栓塞止血成功。86例随访3～18个月,平均6.3月,术后残余结石均排净,肾积水均较术前明显改善。结论B超引导下微创经皮肾穿刺钬激光碎石是治疗上尿路结石的一种简便、安全、有效的方法。

Objective To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） with holmium：YAG laser for upper urinary tract stone. Methods A total of 87 patients with upper urinary tract stone were treated by MPCNL with holmium：YAG laser under the guidance of B-ultrasonography in our hospital. After retrograde placement of the ureteral catheter, a track from the skin surface into the renal calyx was established, and then a holmium laser lithotripter was introduced into the urinary tract under a ureteroscope. The stones were broken into pieces and removed. Results The success rate of the operation was 88.5% （77/87）, and the mean operation time was 85 minutes （ranged from 35 to 190 minutes）. Nine patients had residual stones （ 〉4 ram） in the kidney, and were then treated by ESWL combined with oral dissolution agents. The cure rate of this series was 97.7% （86/87）. The patients were discharged from the hospital 4 to 16 days （mean, 6.3 days） after the treatment. One patient developed massive hemorrhage and was then cured by selective embolization of the small renal vessels. 86 patients were followed up for 3 to 18 months （mean, 6. 3 months）, none of them had residual stones during this period. The symptoms of hydronephrosis was improved in all of the cases. Conclusions B-ultrasonography guided MPCNL with holmium：YAG laser is convenient, safe, and effective for upper urinary tract stone.