B超引导穿刺的微通道经皮肾镜碎石术治疗肾盏结石

Treatment of renal calyceal stones under the guidance of uhrasonography by mPCNL

目的评价B超引导穿刺的微通道（F12F16）经皮肾镜碎石术治疗肾盏结石的安全性和有效性。方法2009年5月2011年8月共收治ESWL无效及透X线肾盏结石44例（44侧肾结石），其中下盏结石24侧，中盏结石11侧，分支性肾盂上盏合并下盏结石9侧，结石长径（16．14±5．12）mm。采用B超引导穿刺的微通道（F12～F16）经皮肾镜碎石术，气压弹道击碎并清除结石。结果44例均一期建立通道并碎石，其中单通道36侧肾，双通道9侧肾；经上盏建立通道9个，经中盏11个，经下盏33个。手术时间（49．3±10．9）min，一期手术结石清除率97．73％（43／44）。术后血红蛋白含量较术前下降（9．13±3．7）g／L。围手术期无输血，与手术相关的感染发生率为6．18％（3／44），主要表现为术后发热，无气胸或腹腔脏器损伤。44例随访6—20个月，平均11．4个月，1例残余结石排出，术后6个月结石复发率为2．27％（1／44），1年结石复发率为6．18％（3／44）。结论B超引导穿刺的微通道经皮肾镜碎石术治疗肾盏结石有效、安全，是此类结石的首选治疗方法。

Objectives To evaluate the safety and therapeutic effect of mPCNL （ mini - invasive percutaneous nephrostolithotripsy） of F12 to F16 in renal calyceal stones under the guidance of B -mode combined with color Doppler ultrasonography. Methods From May 2009 to August 2011, a total of 44 cases of renal calyceal stone failed in ireatment with ESWL and negative stone under X ray, including 24 cases in lower pole calices, 11 cases in middle calices, 9 cases in lower pole calices with a tree branch like collection system. The maximum length of the stones were （16.14 ± 5.12 ）mm. All procedure were under the guidance of B -mode combined with color Doppler, and the pneumatic lithotripsy were used to fragmentate the stone. Results All 44 cases were treated by one - stage PCNL, inculding single tract in 36 kidneys, dual - tract in 9 kidneys. Tracts were eastablished in 9 cases of upper pole caliees, 11 cases of middle calices and 33 in lower pole calices respectively. The one - stage stone free rate was 97.73 % （43/44） with the operation time of （49.3 ± 10.9 ） rain. The hemoglobin declined by （ 9.13 ± 3.7 ） g/L postoperatively when compare with their preoperative counterpart. No perioperative bleeding was recording, and no transfusion was requied. Infection rate related to operation was 6.18% （3/44）, which demostrated by fever. No case experience pneumothorax or peritoneal injury. The follow up duration range from 6 to 20 months （ mean 11.4 months）. Residuary stone discharge was observed in 1 case. The recurrence rate of renal stone was 2.27% （1/44） duing 6 months of follow up, which increased to 6.18% （3/44） after 1 year. Conclusions Using combined B - mode and color Doppler ultrasound guidance during m - PCNL resuhed in safe and effective therapeutic method for calyceal calculus, and can be considered as treatment of choice for this kind of stones.