高龄老年轻度积水上尿路结石的微创治疗体会

Mini-percutaneous nephrolithotomy in the treatment of upper urinary calculi with mild hydronephrosis of elderly patients

目的 探讨微创经皮肾镜取石术（MPCNL）治疗伴有轻度肾积水的高龄老年上尿路结石的安全性和疗效.方法 回顾性分析2011年9月至2013年8月于我科行MPCNL治疗的伴有轻度肾积水的年龄≥70岁的50例上尿路结石患者,对术中、术后安全性,术后疗效及并发症进行评估.结果 50例患者均在B超联合X线下成功建立经皮肾通道.43例行Ⅰ期碎石,18例行Ⅱ期碎石（包括11例Ⅰ期部分碎石后改行Ⅱ期碎石）.手术时间为25～200 min,平均85 min.术中出血10～150mL,平均50mL.住院时间7～16 d,平均9d.Ⅰ期、Ⅱ期和总结石清除率分别为74.4％（32/43）、61.1％（11/18）、86％（43/50）.术后需输血2例,行超选择性肾动脉栓塞1例,术后感染发热（T≥38.5℃）3例,手术侧疼痛需镇痛6例,无血气胸、腹腔脏器损伤等并发症发生.术后随访1月,25例肾功能恢复良好,22例肾功能保持稳定,3例肾功能恢复较差.结论 微创经皮肾镜取石术对伴有轻度肾积水的高龄老年肾结石患者具有疗效好、安全性好、并发症少等优点,适应于大部分高龄老年肾结石患者的治疗.

Objective To evaluate the safety and efficacy of mini-percutaneous nephrolithotomy （MPCNL） in the treat- ment of upper urinary calculi with mild hydronephrosis of elderly patients. Methods Data of 50 elderly patients with upper u- rinary calculi complicated with mild hydronephrosis were retrospectively analyzed. The patients, aged 970 years, were treated with MPCNL during Sep. 2011 to Aug. 2013 in our department. The intraoperative and postoperative safety, efficacy and complications were assessed. Results The percutaneous renal access was successfully established in all cases under the guidance of B-ultrasound combined with X-radiography. Phase Ⅰ lithotripsy was performed in 43 cases and delayed phase Ⅱ lithotripsy in 18 cases （including 11 patients diverted to phase Ⅱ lithotripsy after phase Ⅰ partial lithotripsy）. The operation time was 25- 200 rain, averaged 85min. The blood loss was 10-150 mL, averaged 50 mL. The hospitalization time was 7-16 days, averaged 9 days. The stone-free rate of Phase ~ lithotripsy, Phase Ⅱ lithotripsy and overall stone-free rate were 74.40% （32/43）, 61.1 （11/18） and 86% （43/50）, respectively. After the operation, 2 cases needed blood transfusion, 1 case accepted super-selective renal artery embolization, 3 cases developed fever （T≥38.5℃）, and 6 cases needed analgesia therapy. No serious complica- tions such as pneumothorax, pleural effusion, or abdominal organ damage were reported. During the follow-up of one month, renal functional recovered in 25 cases, remained stable in 22 cases and remained poor in 3 cases. Conclusion Mini-percutane- ous nephrolithotomy is a safe and effective way to deal renal calculi with mild hydronephrosis in elderly patients.