微造瘘经皮肾输尿管镜取石术治疗上尿路结石的临床应用(附450例报告)

Application of mini-percutaneous nephrolithotomy in the treatmennt of upper urinary calculi(report of 450 Cases)

目的探讨微造瘘经皮肾输尿管镜取石术（MPCND治疗上尿路结石的疗效。方法对450例从2000年5月至2009年3月应用MPCNL治疗上尿路结石患者的临床资料进行回顾性分析。结果450例患者均穿刺成功，I期手术时间80±25min，平均76min，估计术中出血量约50-140ml，其中381例行I期取石，61例行Ⅱ期取石，8例行Ⅲ期取石，平均结石清除率90.18％；建立单通道取石443例，双通道取石7例，术后平均住院天数8d，肾造瘘管平均留置时间7.5d，术中术后有明显出血16例，1例出现术后不可控制出血，经介入治疗失败行患肾切除术，余均经保守治疗治愈；2例术后出现尿外渗，经调整肾造瘘管位置后治愈。结论微造瘘经皮。肾输尿管镜取石术治疗上尿路结石安全、有效，对患者创伤小、恢复快、结石清除率高、并发症少，疗效满意。

Objective To assess the efficacy of minimally invasive percutaneous nephrolithotomy （MPCNL） in upper urinary calculi. Methods Data of 450 patients with upper urinary calculi by MPCNL from May 2000 to March 2009 were reviewed and evaluated.Results The puncture successed by one pricking in 450 case. The operation time was 80±25 minutes in I session MPCNL, Total bleeding volume were about 50-140 ml. Among 450 cases,381 cases achieved one-stage MPCNL, 61 cases achieved Ⅱ session MPCNL, 8 cases achieved Ⅲ session MPCNL complete stone clearance rate was 90.18%; 443 case in the establishment of single-channel,7 case in the establishment of double-channel, average hospitalization stay was 8 days,average nephrostomy tube indwelling time was 7.5 days, hemorrhage in 16 case, uncontrollable bleeding after emergence in 1 cases , treatment failure by interventional therapy is in nephrectomy, remaining cured by drug therapy. Urinary extravasation in 2 cases, cured by adjusting the location of nephrostomy fistula. Conclusions MPCNL offers advantages with respect to mini-invasiveness, easy recov- ery,high stone-free rate, less complication and good effect.