内镜直视下扩张皮肾通道的肾实质段行微创经皮肾取石术

Minimally Invasive Percutaneous Nephrolithotomy(MPCNL) Conducted by Expanding Renal Parenchyma of Percutaneous Channel under an Endoscope

目的探讨内镜直视下扩张皮肾通道的肾实质段在微创经皮肾取石术(minimally invasive percutaneousnephrolithotomy,MPCNL)中的应用效果,评估其可行性及安全性。方法 2010年3月～2011年1月,在内镜直视下扩张皮肾通道的肾实质段行MPCNL 156例。方法分两步:第一步,用F8～F20的筋膜扩张器扩张建立铅笔形通道;第二步,用F12李氏肾镜、自行设计的同轴套管扩张器扩张建立圆柱形通道。结果 156例共建立205个皮肾通道,每个通道均一次建立成功,通道扩张的平均时间3 min(1～6 min),扩张中无需X线监视,无穿孔等并发症发生,无介入止血的病例。输血率3.8%。结石一期取净率79%(123/156),二期取净率94%(147/156)。153例随访1～3个月,平均1.6月。KUB+IVU及尿常规检查提示无出血、肾盂输尿管连接部狭窄等并发症发生。结论内镜直视下扩张皮肾通道的肾实质段是可行的,安全的,在内镜直视下扩张可避免穿孔,减少工作鞘切割引起的出血,减少X线暴露时间,提高手术的安全性。

Objective To assess the efficacy, feasibility and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） conducted by expanding renal parenchyma of percutaneous channel under an endoscope. Methods From March 2010 to January 2011, MPCNL was conducted by expanding renal parenchyma of percutaneous channel under an endoscope in 156 patients. The procedure was composed of two steps ： first, F8 - F20 fascia dilators were used to expand and construct a pencil-shaped channel; and then, Fl2 Lee＇ s nephroscope with a self-designed co-axial soft tissue dilator was used to expand and construct a cylindrical channel. Results Totally 205 percutaneous channels were constructed in the 156 patients. All of them were successfully formed at one session; and the mean expansion time for a single channel was 3 min （ 1 - 6 min）. No X-ray monitoring was required during the expansion, no perforation or other complicated occurred, no patient was given intervention hemostasis. The rate of blood transfusion was 3.8%, the stone-free rate in the first stage was 79% （123/156）, and that in the second stage was 94% （147/156）. Conclusions It is feasible and safe to expand renal parenchyma of percutaneous channel under an endoscope. The expansion conducted by endoscopp can avoid perforation, reduce hemorrhage caused by cutting the sheath, decrease the time of exposure to X- ray, and improve the safety of the surgery.