经皮肾镜碎石取石术治疗上尿路结石的1400例分析

Clinical Evaluation of Percutaneous Nephrolithotomy in the Treatment of Urinary Calculi:Report of 1 400 Cases

目的 探讨经皮肾镜碎石取石术（PCNL）治疗上尿路结石的疗效和安全性.方法 对昆明市第一人民医院2002年5月至2013年5月收治的1 400例上尿路结石患者的临床资料进行回顾性分析,其中男性856例,女性544例.年龄6～ 76岁,平均（46±12）岁.肾结石980例,输尿管上段结石420例.结果 1 400例PCNL手术均取得成功,手术时间80～ 150 min,平均（90± 15） min,术中出血量为50～800 mL,平均出血量160mL.平均住院天数为4～7d,一期结石清除率81％,术中术后明显出血43例,8例出现保守治疗难以控制大出血,1例切除患肾,另7例行介入栓塞治疗,余经保守治疗后痊愈.结论 PCNL是治疗上尿路结石的一种有效方法.

Objective To investigate the efficacy and safety of percutaneous nephrolithotomy （PCNL） in the treatment of upper urinary calculi.Methods From May 2002 to May 2013,a total of 1400 patients （856 males and 544 female,range 6-76 years,mean 46 ± 12 years old） with upper urinary calculi underwent percutaneous nephrolithotomy.In 1 400 patients,980 patients got kidney stone and 420 patients got upper ureter stones.The clinical data of all patients were retrospectively analyzed.Results All the procedures were successful.The mean operation time was 90 ± 15 minutes （80-150）,the mean blood loss was 160 mL （50-800）,and average hospital stay was 4-7 days.The stone-free rate after the first operation was 81％ （1 134/1 400）.Massive hemorrhage occurred in 43 cases,uncontrollable bleeding appeared in 8 cases,1 case underwent nephrectomy,and 7 cases were cured by selective embolism of renal artery.Conclusion The PCNL is effective for urinary calculi.