侧卧位B超引导经皮肾镜取石术治疗复杂性肾结石

Percutaneous nephrolithotomy with B ultrasound-guided renal access in the lateral decubitus flank position for complex renal calculi

目的评价侧卧位B超引导下经皮。肾镜取石术（PCNL）治疗复杂性肾结石的疗效及安全性。方法复杂性肾结石患者650例。男512例，女138例。平均年龄38（11～78）岁。结石位于左肾366例，右肾284例。单发121例，多发42例，部分鹿角形结石392例，全鹿角形结石95例。肾结石平均长径31（20～58）mm。均行侧卧位B超引导下PCNL治疗。结果650例手术顺利。B超引导下穿刺均成功，I期微通道气压弹道碎石术493例，标准通道气压弹道和（或）超声联合碎石清石术157例。I期结石取净563例（86．6％），II期取净65例（10．0％），Ⅲ期取净6例，有残余结石者16例联合使用ESWI。治疗。I期PCNL平均手术时间72（35～145）min。未发生气胸、结肠损伤、肾盂穿孔、水中毒、肾周感染等合并症。平均住院时间18（9～32）d。结论侧卧位B超引导下PCNL治疗复杂性肾结石安全有效，患者耐受性好，便于麻醉管理，医护人员和患者避免X线辐射损伤，是一种值得推荐的微创治疗方法。

Objective To evaluate the safety and efficacy of percutaneous nephrolithotomy （PCNL） with B ultrasound guided renal access in the lateral decubitus flank position for complex renal calculi. Methods From June 2004 to August 2009, 650 patients with renal stones ≥20 mm underwent PCNL with B ultrasound-guided renal access in the lateral decubitus flank position. 512 men and 138 women,with a mean age of 38 years（range 11- 78 years）and a mean stone size of al ram（range 20--58 mm）. Results Successful access was achieved in 650 patients （100%）. Minimally PCNL and PCNL were performed in 493 and 157 patients. Complete stone clearance rate was 86.6% （563/ 650）. The mean operative time was 72 min（range 35--145 rain）, and the mean hospital stay was 18d （range 9--32 d）. There were no visceral injuries. Conclusions PCNL with B ultrasound-guided renal access in the lateral decubitus flank position is safe and convenient, and prevents harmful effects of radiation for the surgeon, the surgical team, and the patient.