微创经皮肾镜取石术后结石残留的原因分析

Analysis of cause of residual stones after MPCNL for renal and upper ureteral calculi

目的分析微创经皮肾镜取石术后结石残留的原因,以减少结石残留,提高手术效果。方法回顾分析本院2004年1月至2009年4月所有行微创经皮肾镜取石术患者资料,以出院时的影像资料为依据,对有结石残留的患者进行原因分析。结果在所有行微创经皮肾镜的432例手术中,共有52例患者出院时存在结石残留,其中24例与结石过于复杂有关,11例患者要求出院后体外碎石而未行2次经皮肾镜,3例患者与碎石过程中结石散落有关,4例患者与开展该项技术早期技术操作不熟练和经验不足有关,此外引起结石残留的原因还有肾脏解剖结构异常(2例)、患者不能耐受2次经皮肾镜(2例)、因出血行选择性肾动脉栓塞(2例)、肾周巨大血肿(2例)、2次经皮肾镜不能另外建立通道(1例)、2次经皮肾镜仍出血(1例)。结论引起结石残留的原因主要与结石的复杂性、结石散落、出血及操作者经验有关。

Objective To analyze the cause of stone residue after minimally invasive PCNL（MPCNL） for renal and upper ureteral calculi. Methods All patients who underwent MPCNL in our hospital from January 2004 to April 2009 were retrospected and the patients who had residual stones determined by the imaging examination just before discharged from hospital were enrolled and the cause of residual stones were analyzed. Results There were 52 patients who had residual stones before they were discharged from hospital among total 432 patients undergone MPCNL. Twenty-four patients had residual stones because the stones they burdened were too complex. Eleven patients who had residual stones refused to undergo the second MPCNL and asked for ESWL. The stone fragments scattered into the ealices in 3 patients during fragmentation. Four patients were concerned with insufficient practice and experience in the early stage when we carried out the MPCNL operation. The other causes concerned with stone residue included anatomic structural abnomalities of the kidneys（2 patients）, the patients＇ physical status not enable for the second MPCNL（2 patients） ,selectively renal artery embolism for serious bleeding after MNPCNL（2 patients）, giant perirenal hematomas（2 patients）, and unable to make another percutaneous access tract（1 patient） and serious bleeding（1 patient） during the seeond MPCNL. Conclusion The main causes concerned with residual stones of MPCNL are complexity of urinary calculi, scattering of stone fragments, bleeding and experience of the operator.