经皮肾镜碎石取石术治疗复杂肾结石的临床分析

Clinical analysis of percutaneous nephrolithotomy for treatment of complex renal calculi

目的总结经皮肾镜碎石取石术(PCNL)的学习曲线、手术体会及并发症的防治。方法回顾性分析2005年3月至2009年10月的83例复杂肾结石行PCNL治疗的患者,早期30例及结石直径小于2cm行微通道PCNL的病例,其余病例均行标准通道PCNL。结果83例患者中前30例患者手术时间平均160min,中转开放手术取石5例,结石取尽率72.6%;后53例平均手术时间为100min,结石取尽率85.6%,无严重并发症发生,平均住院时间为12.5d。结论随着临床经验的积累和手术设备的更新,经皮肾镜碎石术对于复杂肾结石治疗的微创、高效的优势将更加明显,手术的安全性也将进一步提高。

Objective To summarize the learning curve, operative experience and prevention of com- plications with 83 cases of complicated renal calculus who underwent percutaneous nephrolithotomy（PCNL）. Methods 83 patients who underwent PCNL by type-B ultrasonic guidance for complex renal calculus from March 2005 to October 2009 were reviewed and evaluated. 30 cases in early phase and cases with stone diameter less than 2 cm were performed mini-PCNL, the other cases were treated by standard PCNL Results The mean operative time of the first 30 cases was 160 minutes, 5 cases were converted to open operation, the stone clearance rate was 72.6%. The mean operative time of the last 53 cases was 100 minutes, the stone clearance rate was 85.6%. No major complications were noted. The mean hospitalization was 12.5 days. Conclusions With the progress of clinical experience and surgical apparatus, higher stone free rate, lower incidence of complications, and more satisfactory reliability of PCNL can be expected.