mPCNL治疗上尿路结石的临床研究(附1061例报告)

Management of Upper Urinary Tract Stones with Mini-PCNL(Report of 1 061 Cases)

目的:探讨微创经皮肾内镜取石术(mPCNL)治疗上尿路结石的疗效及安全性。方法:回顾性分析总结2003年4月～2007年12月应用mPCNL技术治疗上尿路结石1061例的临床资料。肾结石920例,输尿管上段结石141例。651例进行了Ⅰ期取石,374例行Ⅱ期取石,36例行Ⅲ期取石。手术通过单通道取石863例、双通道取石181例、三通道取石17例。结果:平均结石清除率90.1%,平均手术时间86 min,肾造瘘管平均留置6.5天,平均住院13天。术中8例输血,6例术后因发迟发性大出血需要输血,其中3例经高选择性肾动脉栓塞治愈。5例术后出现尿外渗,经调整肾造瘘管位置及充分引流肾周后治愈。在开展的早期,1例患者因出血、冲洗液外漏并大量重吸收而致死亡。结论:mPCNL治疗上尿路结石安全、高效,具有并发症少、创伤小、结石清除率高、恢复快、住院时间短等优点,是治疗上尿路结石的一种好方法。

Objective： To study the efficacy and safety of minimally invasive percutaneous nephrolithotomy （mPCNL） in treatment of upper urinary tract calculi. Methods： The clinical data of 1 061 patients suffering from renal calculi and upper ureteral calculi treated with mPCNL from April 2003 to December 2007 were investigated retrospectively. There were 920 cases of renal stones and 141 cases of upper ureteral stones. Among the cases, onestage mPCNL was performed in 651 cases, two stage in 374 and three--stage in 36. The mPCNL was done by single tract in 863 cases, double tracts in 181 cases and triple tracts in 17 cases respectively. Results：The average stone free rate was 90.1%, average operative time was 86 minutes, average nephrostomy tube stay was 6.5 days , and average hospital stay was 13 days. Blood transfusion was needed in 8 cases during the operation, and was need in 6 cases because of postoperative massive hemorrhage. 3 of those 6 cases were treated by selective embolism of renal artery to receive nemostasis. Urinary extravasation was seen in 5 cases, which was cured by adjustment of nephrostomy tube and thoroughly drainage of renal surrounding. 1 patient died in the early stage of the mPCNL procedure because of a large amount of fluid absorption and hemorrhage. Conclusions： mPCNL is safe and effective and is a good option to treat upper urinary tact calculi. It offers advantages with respect to less introoperative and postoperative complications, high stone free rate, less invasion, early recovery and short hospital stay.