微通道经皮肾镜碎石治疗肾合并输尿管上段结石疗效分析

Therapeutic effect analysis of minimally invasive percutaneous nephrolithotomy for the treatment of renal and upper ureteral calculi

目的探讨微通道经皮肾镜气压弹道碎石治疗肾合并输尿管上段结石的疗效与方法。方法回顾性分析41例肾合并输尿管上段结石患者的临床资料。结果 41例患者均一期穿刺成功,一期结石清除率70.73%(29/41),1例患者因术中出血较多行二期取石,7例肾脏结石残留,再次经原通道取石,未建立新通道取石,5例术后一月复查KUB平片提示输尿管残留结石,行中药排石或体外冲击波碎石治疗,残留结石顺利排出。手术时间平均(115±25)min,术中出血量平均(120±15)mL,1例患者术中术后出血较多予输血治疗。2例患者术后出现高热,经加强抗感染治疗后恢复正常。结论微通道经皮肾镜气压弹道碎石治疗肾合并输尿管上段结石,具有微创、恢复快、并发症少、清除结石率高、可重复取石等优点,是首选的手术方法。

Objective To study the efficacy and way of minimally invasive percutaneous nephrolithoto- my（ MPCNL） in treating renal and upper ureteral calculi. Method A retrospective analysis was reviewed of 41 patients with renal and upper ureteral calculi treated by MPCNL. Results In all the 41 cases, the nephrostomy tract was established successfully on one-stage, with a one-stage stone clearance rate of 70.73% （29/41）. One case underwent tow-stage MPCNL for blood loss during the operation, and 7 underwent the two-stage operation through the same tract for renal stone residual. Five cases of residual stone were observed by kidney-ureter-bladder-X-ray and their calculi were eliminated with Chinese medicine or extracorporeal shock-wave lithotripsy（ESWL）. The operation time was（ 115± 25 ） rain, and blood loss was （ 120 ± 15） ml. After operation, 1 received blood transfusion because of blood loss during, and 2 developed high fever , but all were controlled by medicine. Conclusion MPCNL has the advantages of minimally invasion, rapid recovery, low incidence of complication, high rate of stone clearance, and repetition, indicating it as the optional choice for the treatment of renal and upper ureteral calculi.