彩超引导下微创经皮肾镜治疗复杂性上尿路结石

Color Doppler Ultrasound Guided Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Calculi

目的评价彩超引导下微创经皮肾镜治疗复杂性上尿路结石的安全性及有效性。方法从2009年1月至2012年3月,207例复杂性上尿路结石(肾鹿角型结石85例、肾多发性结石81例、肾结石并输尿管上段结石35例、马蹄肾结石6例)在彩超引导下行微创经皮肾镜碎石术。结果 207例均手术成功,无中转开放手术者。一期碎石取净结石155例,二期碎石取净结石32例,一期清石率74.88%(155/207),总结石清除率90.34%(187/207),20例残余肾结石,术后行ESWL辅助治疗。3例患者术后反复出血,经选择性或超选择性肾动脉栓塞止血后治愈出院。结论彩超引导下微创经皮肾镜治疗复杂性上尿路结石具有安全、有效和创伤小等优点。

Objective To evaluate the efficiency and safety of minimally invasive percutaneous nephrolithotomy （MPCNL） under guide of color Doppler ultrasound for complex renal calculi. Methods From 2009 January to 2012 March, MPCNL under the guide of color Doppler ultrasound 207 cases of patients with complex renal calculi underwent minimally invasive percutaneous nephrolithotomy, including 85 cases of renal staghorn calculi, 81 multiple renal calculi, 35 renal and upper ureteral calculi and 6 renal horseshoe calculi. Results 207 cases were successful with no case transferred to open operation. 155 patients got stone clearance at stage one, 32 patients got stone clearance at stage two, the total stone clearrance was 74.88% （155/207）, 20 cases required ESWL with residual stones. 3 patients with postoperative recurrent bleeding were successfully treated by selective or superselective embolization. Conclusions Minimally invasive percutaneous nephrolithotomy under guide of color Doppler ultrasound for complex renal calculi is safe, effective, and less traumatic.