X线监视下微创经皮肾镜取石术治疗上尿路结石

The treatment of upper urinary calculus with minimally invasive percutaneons nephrolithotomy under the guidance of radiography

目的探讨X线监视下微创经皮肾镜取石术（MPCNL）治疗上尿路结石的疗效及安全性。方法回顾分析应用X线监视下MPCNL治疗上尿路结石132例患者的临床资料。结果132例138侧均成功施行经皮。肾穿刺并建立通道，单通道取石125例131侧，双通道取石7例7侧。一期取石125例129侧，二期取石7例9侧。平均结石清除率90．6％，平均手术时间86min，平均出血量70ml，术中均未输血。术中无肝脾及肠管损伤等并发症发生；术后发热7例（5．3％），平均住院时间10d。结论X线监视下MPCNL具有损伤小、出血少、并发症少、恢复快、结石清除率高等优点，是治疗上尿路结石安全有效的方法。

Objective To evaluate the safely and the clinical outcomes of minimally invasive percutaneous nephrolithotomy in the treatment of upper urinary calculus under the guidance of radiography. Methods 138 renal units of 132 cases of upper urinary calculus underwent minimally invasive percutaneous nephrolithotomy under the guidance of radiography were retrospectively analyzed. Results 138 renal units of 132 cases established percutaneous access successfully. The number tracts required per procedure were 1 tracts in 131 renal units of 125 cases ,2 tracts in 7 renal units of 7 cases. 129 renal units of 125 cases underwent MPCNL at phase 1 lithotripsy. The stage 2 lithotripsy was carried in 9 renal units of 7 cases. The overall rate of fragmentation for upper urinary calculus was 90. 6% ; The mean operative time was 86min;mean blood loss was 70ml;No case was given transfusion. No perioperative complications such as pneumatothorax, trauma of liver, spleen or intestine occurred. Cardiothoracic fever or hyperpyrexia was seen in 7 cases（5.3% ）. The mean length of stay was 10 days. Conclusions Minimally invasive percutaneous nephrolithotomy under the guidance of radiography is an economic and effective method for the treatment of upper urinary calculus. The procedure is superior in safety, less hemorrhage ,less complication and the high rate of stone free.