经皮肾镜碎石术治疗上尿路结石750例临床分析

Clinical evaluation of percutaneous nephrolithotomy in the treatment of upper urinary calculi:Report of 750 cases

目的探讨经皮肾镜碎石术(PCNL)治疗上尿路结石的疗效。方法对我院2002年5月至2010年5月收治的750例上尿路结石患者的临床资料进行回顾性分析,其中男410例,女340例;年龄6～74岁,平均年龄40±13岁。肾结石620例,输尿管上段结石130例。结果 750例PCNL手术均成功,手术时间80～130min,平均90±25min,术中出血量为50～800ml,平均出血量110ml,输血10例。术后平均住院时间为6.5d,肾造瘘管留置时间为4～8d。Ⅰ期结石清除率为86%(645/750),Ⅱ期结石清除率为91.8%(689/750)。术中术后明显出血16例,2例出现保守治疗难以控制大出血,1例切除患肾,另1例行介入栓塞治疗,必经保守治疗后痊愈。结论 PCNL是治疗上尿路结石的一种有效方法,创伤小、恢复快。

Objective To evaluate the efficacy of percutaneous nephrolithotomy （PCNL） in the treat- ment of upper urinary calcu｜i. Methods From May 2002 to May 2010, a total of 750 patients （410 males and 340 female, range 6-74 years, mean 40±3 yeaxs old） with upper urinary calculi underwent percutaneous nephrolithotomy. In 750 patients, 620 patients got kidney stone, 130 patients got upper ureter stones. Re- stilts All the procedures were sucessful. The mean operation time was 90＋25 minutes （80-130） , The mean blood loss was 110 m1（50-800）, Blood transfusion was needed in 10 patients. Average hospital stay was 6.5 days. The duration of nephrostomy tube indwelling was 4-8 days. The stone-free rate after the first opera- tion was 86%（645/750）. 105 patients accepted another PCNL to remove the residual calculi.The stone-free rate of this group was 91.8% （689/750）. Massive hemorrage occurred in 16 cases, uncontrollable bleeding after emergence in 2 cases, one case underwent nephrectomy, and the other was cured by selective em- bolism of renal artery. Conclusions The PCNL is effective, fast-recovery, minimally invasive for the treatment of the stone disease of the upper urinary track.