斜仰卧位微造瘘经皮肾镜取石术治疗输尿管上段结石临床分析

Minimally invasive percutaneous nephrolithotomy in flank position for management of proximal ureteral calculi

目的探讨斜仰卧位微造瘘经皮肾镜取石术治疗输尿管上段结石的临床应用价值。方法分析我院2008年6月至2010年6月采用斜仰卧位微造瘘经皮肾镜取石术治疗输尿管上段结石52例的临床资料。其中男33例,女19例,年龄23～65岁,平均42岁。均为单侧输尿管结石,结石长径1.0～3.2cm,合并患侧肾结石15例。结果所有患者行PCNL均成功,无中转开放手术。平均手术时间80min(55～110min)。术中无大出血和肠道损伤、胸膜损伤等并发症。50例一期PCNL清除结石,一次碎石成功率为96.2%。术后随访3～6月,复查超声或IVU,提示患肾积水不同程度减轻,无输尿管狭窄或结石复发。结论斜仰卧位微造瘘经皮肾镜取石术治疗输尿管上段结石技术可行,安全有效,对于患者和术者均比较舒适,可作为mPCNL的理想体位选择。

Objective To evaluate the clinic efficacy of minimally invasive percutaneous nep- hrolithotomy（MPCNL） in flank position for the management of proximal ureteral calculi. Methods Between June 2008 and June 2010; 52 patients with hemilateral proximal uretheral calculi underwent MPCNL in flank position, of the 52 cases, 15 of them combined with kidney stone, the maximal stone size was 1.0-3.2 cm. Results A total of 52 MPCNL were performed, the mean operative time was $0min （range, 55-110 min）, mean hospital stay was 5 d （range, 5-10 d）. 50 cases were finished by single access, the rest 2 Cases were recieved second phrase PNCL cause of residual stone, the calculi-free rate was 96.2%. No massive haemorrhage or severe complication occurred. Conclusion MPCNL is safe and feasible, and flank position provide not only more comfortable for the patient, but also convience for the surgeon and anesthetist.