上尿路结石行无支架管PCNL治疗初探

Stentless percutaneous nephrolithotomy for upper urinary tract calculus:a preliminary report of 13 cases

目的:探讨无支架管经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)治疗上尿路结石(upper urinary tract calculus,UUTC)的安全性及有效性。方法:回顾性分析13例UUTC患者的临床资料:男9例,女4例,年龄21～64岁,平均41岁;输尿管上段结石5例,肾结石8例;结石直径0.6～2.5cm,平均1.5cm;数量1～3枚,平均1.7枚。均行11肋下PCNL,术中输尿管未放置D-J管。术后第1天复查KUB。结果:手术均顺利,手术时间25～90min,平均45min。术后10例(76.9%)结石取净,2例(15.4%)肾残留结石碎末,1例(7.7%)输尿管残石梗阻,于术后第2天置入D-J管并3周后拔出。术后均4天内拔除肾造瘘管及尿管出院。随访4～28个月,平均14.6个月,无继发结石、肾积水及输尿管狭窄。结论:对于结石体积较小、数量较少的UUTC行无支架管PCNL,手术安全有效,免除了术后拔除D-J管的痛苦,降低了相关费用。

Objective：To introduce our experiences and assess clinic safety, outcome and efficacy of stentless percutaneous nephrolithotomy（PCNL） performed for upper urinary tract calculus（UUTC） in selected cases. Meth- od..A retrospective study was done in 13 patients （9 men and 4 women） underwent stentless PCNL for UUTC （re- nal calculus in 8 cases and upper ureter calculus in 5）. The average diameter and amount of stones were 1.5 cm （0.6 cm to 2.5 cm） and 1.7（1 to 3）, respectively. In all cases, no double J stent was placed in ureter during PC- NL procedures. All patients took an x--ray of KUB region the next day. Resuit..All 13 patients underwent success- fully spinal stentless PCNL. The average procedure time was 45 min （25 min to 90 rain）. There was complete stone clearance in 10 cases （76.9~）. Residual renal stone fragments in 2 cases （15.4%） were small and treated by traditional chinese medicine. In one patient （7.7%）, a double J stent was implanted for residual stones ob- struction in ureter and removed, 2 days and 3 weeks after PCNL, respectively. All were dislodged nephrostomy tube and discharged uneventfully after 4 days stay without infection or other complications. During 4 to 28 months follow--up （mean 14.6 months）, no hydronepherosis, calculus or ureteral obstruction was shown in all patients by ultrasonography or KUB＋IVP. Conclusion..Stentless PCNL is technically feasible and viable option to select patients with small and less UUTCs. It decreases cost and avoids discomfort to dislodge D-J stent.