彩超引导下微创经皮肾镜碎石取石术治疗复杂性上尿路结石的临床应用

Clinical application of minimally invasive percutaneous nephrolithotomy in the treatment of complex upper urinary tract calculi with color doppler ultrasound guidance

目的探讨彩色多普勒超声(彩超)引导下微创经皮肾镜技术(MPCNL)取石治疗复杂性上尿路结石的疗效。方法于彩超引导下采用MPCNL治疗106例复杂性上尿路结石患者,评价手术疗效。结果 106例均手术成功,一期手术时间(50±20)min,二期手术时间(30±10)min;一期结石清除率75.5%(80/106),总结石清除率86.8%(92/106),所有患者术中均无需输血及无出现严重并发症。有残余肾结石的14例采用体外冲击波碎石或口服排石药排出残余结石。1例出现术后大量出血,经介入科行超选择性肾动脉栓塞术后治愈。术后平均随访12个月,2例出现术后残余结石排至输尿管上段,经体外冲击波碎石治疗后结石自行排出,其余患者无明显并发症。结论彩超引导下MPCNL治疗复杂性上尿路结石疗效较好。

Objective To investigate the clinical value of color doppler ultrasound guided minimally invasive percutaneous nephrolithotomy （ MPCNL ） in the treatment of complex upper urinary tract calculi. Methods One hundred and six patients with complex upper urinary tract calculi were treated by MPCNL with color doppler ultrasound guidance and then the treatment effect was analyzed. Results All surgeries were successful. The operation time of one-stage operation was （50 ± 20） min and that of two-stage operation was （ 30 ± 10） min. Eighty patients （75.5%） got stone clearance after one-stage operation and the total stone clearance rate was 86. 8%. No patient needed blood transfusion and no severe complications occurred during the operation. Fourteen patients had residual stones and were cured by extracorporeal shock wave lithotripsy or oral platoon stone medicines. One patient suffered a massive haernorrhage after operation and was cured by super selective .arterial embolization treatment. The average follow-up time after surgery was 12 months. During the follow-up period, there were no other significant complications except 2 cases with residual stones located in the upper ureteral calculi, whose stone was cleared after extracorporeal shock wave lithotripsy treatment. Conclusion Color ultrasound guided MPCNL for complex upper urinary tract calculi is effective.