微创经皮肾造瘘输尿管镜碎石术治疗肾输尿管上段结石疗效观察

Minimal invasive percutaneous nephrolithotripsy for the treatment of upper urinary tract stones

目的探讨微创经皮肾造瘘输尿管镜碎石术治疗。爵、输尿管上段结石的疗效。方法回顾性分析2004年9月至2008年9月86例接受微创经皮‘肾造瘘输尿管镜碎石术的肾、输尿管上段结石患者的临床资料，对术中取石情况、手术时间、术后并发症等情况进行总结。结果86例患者中有72例Ⅰ期取石，13例Ⅱ期取石，1例Ⅲ期取石。单通道取石78例，双通道取石8例，平均手术时间106min，肾造瘘管平均留置时间7d，平均住院15d。1例因术中肾皮质撕裂伤大出血，术中紧急输血改开放手术；1例术中顺行留置双J管困难，改行逆行输尿管镜检查后留置；9例肾盏内有小结石残留，经体外震波碎石后治愈。结论微创经皮肾造瘘输尿管镜碎石术治疗肾、输尿管结石具有安全、有效，创伤较小、恢复较快等特点。

Objective To evaluate the curative effects of renal or upper ureteral stones treated by means of minimal invasive percutaneous nephrolithotripsy（mPCNL）. Methods Totally 86 cases of patients were treated with mPCNL and their clinical data were reviewed retrospectively, Rsults Seventy-two patients were rendered stone-free at 1 session; 13 patients were rendered stone-free at 2 session; 1 patient were rendered stone-free at 3 session. Seventy-eight cases were operated through single-road;8 cases were operated through double-road. The stone free rate was 88.5% ;the average time of operation was106 rain; the average time of the nephrostomy tube was 7 days; the average hospitalization was 15 days;the renal cortex of 1 case was tore apart during operation and intraoperative blood transfusion and open surgery were needed;the double-J of 1 case could not be put into bladder through ureter; the stones were cleared off in 9 cases by ESWL after mPCNL. Conclusion Minimal invasive porcutaneous nephrdithotripsy is safe and effective in treating renal or upper ureteral stones;compared to traditional PCNL,it may offer advantages with respect to less invasion and easy recovery.