超声引导下经皮肾碎石清石术治疗上尿路结石381例临床分析

Clinical analysis of B-ultrasound guided percutaneous nephrolithotomy for upper urinary tract stones: report of 381 cases

目的探讨超声引导下经皮肾碎石清石术治疗上尿路结石的安全性和有效性。方法2006年1月至2011年6月采用超声引导下建立经皮肾通道行经皮肾镜碎石清石术治疗上尿路结石381例。总结分析手术方法、手术时间、结石清除率及并发症等情况。结果376例患者超声引导下一次穿刺成功建立经皮肾通道，5例因穿刺或扩张时出血明显，及时终止手术。碎石清石总成功率为93．6％（352／376）。287例肾结石患者一期结石清除率为70．3％（201／287），65例输尿管上段结石患者一期结石清除率为95．3％（62／65）。二期碎石48例，23例残留结石0．5～1．0Gm者以ESWL治疗，23例残留结石≤0．4cm经体位排石等保守治疗排净。平均手术时间110．5±28．6min；术中平均出血量104±37．2ml；输血5例；肾造瘘管留置时间平均8d；术后平均住院时问9d；3例大出血行选择性肾动脉栓塞治疗后痊愈；1例术后发现气胸行胸腔闭式引流后痊愈；1例术后出现肾周巨大血肿，行保守治疗后好转；术后低、中度发热者31例，高热者5例。结论超声引导F经皮肾碎石清石术治疗上尿路结石创伤小、恢复快、安全高效、并发症少，疗效可靠。

Objective To investigate the efficacy and safety of percutaneous nephrolithotomy （PCNL） under B-ultrasound guidance for treatment of upper urinary tract calculi. Methods From January 2006 to June 2011, 381 patients with upper urinary tract calculi who underwent PCNL by the guidance of B-uhrasound were enrolled into this study. The procedures, stone clearance rate, operative time and complication were analysed respectively. Results Of the 381 cases, 376 patients underwent PCNL at phaes I lithotripsy. The punctures from skin to kidney succeeded and the 16-20 F renal channels were established successfully in these patients. Five cases ended operation due to bleeding in establishing percutaneous renal tract. The total stone-free rate was 93.6%（352/376）. Of the 287 patient with kidney stone, the stone-free rate after phase 1 operation was 70.3% （201/287）. Of the 65 patient with upper ureter stone, the stone-free rate after phase I operation was 95.3% （62/65）. Phase II lithotripsy was performed in 48 cases. Twenty-three cases with residual stones ranged 0.5-1.0 cm received adjuvant extracorporeal shock wave lithotripsy, while 23 cases with stones less than 0.4 cm discharged stones completely after conservative therapy. The average operative time was 110.5±28.6 rain. The average blood loss was 104±37.2 ml. Five cases needed blood transfusion. The average duration of nephrostomy tube indwelling was 8 days. The average postoperative hospital stay was 9 days. Three cases of severe hemorrhage were cured with superselective angiographic embolization. One case of giant perirenal hematoma postoperatively was cured with conservative therapy. One case of pneumothorax was cured with closed thoracic drainage. Low fever was observed in 31 patients after operaion, whereas high temperature was noted in 5 cases. Conclusion For upper urinary tract calculi, B-ultrasound guided PCNL is safe and effectively, with less trauma and lower compliation rate. The therapeutic effects is reliable.