侧卧位微创经皮肾镜取石术48例报告

Minimally Invasive Percutaneous Nephrolithotomy in the Lateral Position:Report of 48 Cases

目的探讨侧卧位施行微创经皮肾镜取石术（minimally invasive pereutaneous nephrolithotomy,MPCNL）的可行性与疗效。方法2004年7月-2007年10月48例上尿路结石（鹿角状结石12例,结石直径为2.2-5.8cm;肾盂肾盏多发性结石31例;输尿管结石5例）取侧卧位,头低10°,脚低20°,在C形臂X线机或B超定位下作肾穿刺,建立微创经皮肾取石通道,输尿管镜气压弹道碎石或钬激光碎石,灌注泵冲洗结合取石钳取石。结果除1例因穿刺困难改用俯卧位完成MPCNL外,余47例均顺利完成手术,其中41例为一期手术,6例为一期置管,二期取石。无中转开放手术。手术时间（137.5±39.6）min。一期手术结石清除率82.9%（34/41）。无术中大出血,无胸膜损伤及周围脏器损伤等并发症。21例随访1-3个月,术前肾积水17例中,11例肾积水消失,6例减轻;4例残余结石中,1例1个月后再次体外震波碎石后结石排净,其余3例经中药排石,2例结石排净。结论侧卧位施行MPCNL,有利于术中麻醉监护,在绝大部分情况下可顺利完成MPCNL,手术效果良好。

Objective To evaluate the feasibility and efficacy of minimally invasive percutaneous nephrolithotomy （MPCNL） in the lateral position. Methods A total of 48 patients with staghorn （ 12 cases, 2.2 to 5.8 cm in diameter） or multiple renal calculi （31） or upper ureteral stones （5） were treated with MPCNL in our hospital between July 2004 to October 2007. The patients were placed in a lateral position with the head 10° lower and the feet 20° lower. The puncture was made under the guidance of X-ray or ultrasonography, and then Holmium laser or EMS lithotripter was used for stone fragmentation. The stone debris was removed by irrigation. Results The procedure was completed in all of the 48 patients except one, who was converted to a supine position because of the difficulty in puncture. Among the 47 cases, 41 were cured with the first operation, the other 6 received catheterization in the first procedure, and then underwent calculi removal in a second,stage operation. None of the patients were converted to open surgery. The mean operation time in this series was （ 137.5 ±39.6） min. The one-stage cure rate in our patients was 82.9% （34/ 41 ）. None of the cases had massive blood loss, or injuries to the pleura and other organs. Follow-up was available in 21 cases for 1 to 3 months. During the period, among the 17 patients who had hydronephrosis, 11 were cured and 6 were improved; and among the 4 who had residual stones, 1 received ESWL in 1 months after the first operation and was cured afterwards; the other 3 were treated by traditional Chinese medicine, 2 of them were cured. Conclusions The MPCNL performed on the patients in the lateral position is an effective alternative for renal calculi,and favorable to intra-operative anesthesia monitor.