超声引导下微通道经皮肾镜取石术治疗肾下盏结石68例观察

Minimally Invasive Percutaneous Nephrolithotomy Guided by B-ultrasonography in Treatment of Lower Renal Caliceal Calculi(Report of 68 cases)

目的：探讨B超引导下微通道经皮肾镜取石术（MPCNL）治疗肾下盏结石的方法和疗效,以及适应证的选择。方法：分析2007年12月至2013年12月应用B超引导下MPCNL治疗肾下盏结石68例。均采用16F通道取石,其中48例为下盏单通道,18例为中盏单通道,2例为中盏、下盏双通道,结石直径1.0~2.8 cm（平均2.2 cm）。结果：68例患者中,1次清石成功率91.18%（62/68）,3例再次手术后取净结石,1例结石（长径〉0.5 cm）残留术后结合ESWL治疗,2例结石（长径〈0.5 cm）残留未作处理。手术时间30~115 min（平均55 min）,术中出血量25~260 m L（平均85 m L）,未发生出血等严重并发症,无中转开放手术病例,患者术后住院6~9 d。40例患者术后回访6~48个月（平均22个月）无结石复发。结论：B超引导下MPCNL治疗肾下盏结石安全、微创、恢复快。对直径〉1.0 cm特别是〉2.0 cm的肾下盏结石,MPCNL可作为首选。

Objective： To investigate the methods,efficiency and indications choice of minimally invasive percutaneous nephrolithotomy（ MPCNL） in treatment of lower renal caliceal calculi. Methods： 68 patients who- underwent B- ultrasonography- guided MPCNL for lower caliceal calculi from December 2007 to December 2013 were reviewed retrospectively. 16 F renal access nephrostomy were performed in all 68 cases. Renal lower calyx single channel were in 48 cases,middle calyx single channel were in 18 cases and lower and middle calyx twe channel were in 2 cases. The mean size of calculi was 2. 2（ 1. 0- 2. 8） cm. Results： 62cases（ 91. 1%） achieved stone removed in 1 time; MPCNL was needed once again in 3 cases for the residual stone; ESWL was adopted in 1 case with residual calculi diameter 0. 5 cm; 2 cases with residual calculi diameter 0. 5 cm were not treated. The average operating time was 55 min（ 30- 115 min） and the average blood loss was 85 m L（ 25- 260 m L）. No severe complications occurred in any patients. None had incision operation. The hospital stay afer surgery was 6- 9 days. 40 cases were followed up for6 to 48 months（ mean 22 months）,and no recurrent calculi was revealed. Conclusion： B- ultrasonography- guided MPCNL has the advantages of safety,less invasion and easy recovery in treatment of lower caliceal calculi. MPCNL should be considered as the first method of treatment for the patients with caliceal calculi 1. 0 cm,especially in lower caliceal calculi 2. 0 cm.