微创经皮肾镜取石术治疗上尿路结石(附2050例报告)

Treatment of upper urinary calculi with minimally invasive percutaneous nephrolithotomy(report of 2050 cases)

目的：探讨微创经皮肾镜取石术（mPNL）治疗上尿路结石的疗效和安全性。方法：回顾性分析我院2007年6月至2013年10月利用微创经皮肾镜取石术治疗的2050例上尿路结石患者的临床资料。其中肾盂或肾盏结石879例,部分和完全性鹿角形结石共571例,输尿管上段结石587例,肾结石合并输尿管结石13例。肾结石大小18～108 mm,输尿管结石大小9～36 mm。结果：结石清除率为：输尿管上段结石99.5%（584/587）,单纯肾盂或肾盏结石为96.2%（846/879）,鹿角形肾结石85.6%（489/571）。术后输血患者8例（0.39%）,行高选择性肾动脉栓塞3例（0.15%）,发生寒战高热15例（0.73%）,感染性休克1例（0.05%）,胸腔积液3例（0.15%）,1例行胸腔穿刺引流,改行开放手术2例（0.10%）;无死亡及肾切病例。结论：微创经皮肾镜取石术治疗上尿路结石安全、有效、并发症少,结石清除率高。

Objective： To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy（mPNL） for the treatment of upper urinary calculi. Methods： The clinical data of 2150 cases of upper urinary calculi treated by mPNL from June 2007 to October 2013 were analyzed retrospectively, including 879 pelvic or calyx calculi,571 partial and overall staghorn renal calculi, 587 upper ureter calculi, and 13 renal calculi combined with ureter calculi. The renal stone size ranged from 18 to 108 mm and ureter stone size from 9 to 36 mm. Results： The stone-free rate of staghorn renal calculi was 85.6%. The pelvic and calyx calculi was 96.2%.The ureterolithiasis was 99.5%. 8cases（0.39%） were given blood transfusion for hemorrhage and 3 cases（0.15%） received super-selective renal arterial embolization. Chills and high fever were seen in 15 cases（0.73%）, followed by infectious shock in one case（0.05%）. 3cases（0.15%） complicated with pleural effusion, among them one needed pleural puncture for hydrops outflow, 2 cases（0.10%）converted to open surgery. There were no death and nephrectomy in all the paitients. Conclusion： Minimally invasive percutaneous nephrolithotomy for treatment of upper urinary calculi is safe and effective, with fewer complications and higher stone-free rate.