B超引导下经皮肾微造瘘钬激光碎石术治疗复杂性肾结石132例报告

Minimally invasive percutaneous nephrolithotripsy with holmium laser under B ultrasound guidance for treatment of complicated renal calculi(a report of 132 cases)

目的探讨B超引导下经皮肾微造瘘钬激光碎石术治疗复杂性肾结石的临床疗效。方法2007年3月～2008年11月采用B超引导下经皮肾微造瘘钬激光碎石术治疗复杂性肾结石132例,并对手术方法及并发症进行分析。结果126例患者1次穿刺成功建立经皮肾微通道,6例因穿刺或扩张通道时出血明显,及时结束手术。一期结石清除率为57.6%(76/132),二期碎石22例,13例残石大小0.5～1.2cm者辅以ESWL治疗、21例结石大小≤0.4cm者经体位排石等保守治疗排净。平均手术时间106min,手术出血量平均60mL,输血3例。术后低、中度发热者13例,高热者3例。术后平均住院7.5d。结论B超引导下经皮肾微造瘘钬激光碎石术治疗复杂性肾结石操作方法安全,疗效可靠。

[ Objective ] To report the experience of management of complicated renal calculi by minimally invasire pereutaneous nephrolithotripsy （MPCNL） with holmium laser under B ultrasound guidance. [Methods] From March 2007 to November 2008, 132 patients with complicated renal calculi underwent MPCNL using holmium laser under the guide of B ultrasound. The procedures and complications were analysed respectively.[Results ] Of the 132 cases, 126 patients underwent MPCNL at phase I lithotripsy. The punctures from skin to kidney succeeded and the F16 renal channels were established successfully in these patients. Six cases ended operation due to bleeding of established percutaneous renal tract. The stone-free rate after phase I operation was 57.6% （761132）. Phase II lithotripsy was performed in 22 cases. Thirteen cases with residual stones of 0.5-1.2 cm received adjuvant extraeor- poreal shock wave lithotripsy while 21 with stones less than 0.4 cm discharged stones completely after conservative therapy. The average operative time was 106 min. The average blood loss was 60 mL. Three cases needed blood transfusion. Low fever （〈39℃） was seen in 13 patients after operation, whereas high temperature was noted in 3. The mean postoperative hospital stay was 7.5 days. [ Conclusions ] It is safe and effective to treat the patients with complicated renal calculi by MPCNL using holmium laser under B ultrasound guidance.