经皮肾镜取石术治疗肾脏下盏结石疗效观察

The Treatment of Lower Renal Caliceal Calculi by Percutaneous Nephrolithotripsy

目的:探讨新型标准经皮肾镜取石术(PCNL)和微创经皮肾镜取石术(MPCNL)治疗肾脏下盏结石的安全性和疗效。方法:回顾性分析68例肾脏下盏结石的患者临床资料,采用新型肾镜治疗31例,微创经皮肾镜治疗37例;Ⅰ期碎石63例,选择中盏通道28例,下盏通道40例。结果:新型肾镜手术时间(2.18±0.57)h,平均住院时间(11.65±2.18)天;微创肾镜手术时间(1.89±0.56)h,平均住院时间(10.57±2.41)天,二者相比差异无统计学意义。术后复查KUB平片,57例排净结石,结石清除率为83.8%(57/68);残石11例,再次PCNL 5例,带D-J管体外碎石6例,无严重并发症出现。结论:新型标准经皮肾镜取石术和微创经皮肾镜取石术治疗肾脏下盏结石是有效、可行的,是治疗下盏结石的合适选择。

Objective：To investigate the safety and efficiency of percutaneous nephrolithotripsy and minimally invasive percutaneous nephrolithotripsy for the treatment of lower renal caliceal calculi. Methods：Clinical data of sixty eight patients who underwent PCNL or MPCNL for lower caliceal calculi from 2005 to 2009 were reviewed retrospectively. 31 cases PCNL and 37 cases MPCNL. The percutaneous renal access was successfully established and phase I litbotripsy was performed in 63 patients. Renal access was obtained through middle calyx in 28 cases and a lower calyx in 40. Results：The average operative time in PCNL group and MPCNL group was 2.18±0.57 h and 1.89±0.56 h. The average hospital stay was 11.65±2. 18 days and 10.57±2.41 days. There was no signifi- cant difference between the two groups. No residual stone fragment in 57 cases, stone free rate was 83.8% （57/ 68）. Residual stone fragment was found in 11 cases by postoperative KUB. 5 cases received second PCNL and 6 cases received ESWL. No severe complications occurred. Conclusions： PCNL and MPCNL were safe and efficient methods for the treatment of lower caliceal calculi.