微通道经皮肾镜取石术治疗上尿路结石2724例经验总结

Treatment of upper urinary calculi with MPCNL: experience in 2,724 cases

目的探讨微通道经皮肾镜取石术(MPCNL)治疗上尿路结石的有效性和安全性。方法对我院泌尿外科2004年1月至2013年12月收治的MPCNL治疗上尿路结石2 724例的临床资料进行回顾性分析。结果本组共2 724例患者(2 835个肾),行MPCNL 3 078次。其中,Ⅰ期手术2 696次(87.59%),Ⅱ期手术357次(11.60%),多次手术25例(0.81%)。采用单通道碎石2 786例(98.27%),双通道碎石44例(1.55%),三通道碎石5例(0.19%)。术后患者行ESWL和(或)输尿管软镜辅助治疗173例(6.35%)。手术时间(120.4±50.5)min。MPCNL术后总结石清除率91.2%,行ESWL和(或)输尿管软镜辅助治疗后结石清除率为94.1%。住院时间(10.6±3.2)d。术中或术后输血61例(2.24%),因出血严重术后行选择性肾动脉栓塞术8例(0.29%)。术后肾破裂致肾切除1例(0.04%)。术后发现结肠损伤1例(0.04%)、胸膜损伤5例(0.18%)。术后感染性休克28例(1.03%),其中因感染性休克死亡1例(0.04%)。术后7 d因肺栓塞致死亡1例(0.04%)。结论微通道经皮肾镜取石术具有创伤小、并发症少、结石清除率高等优点。治疗上尿路结石安全、可靠、高效。

Objective To evaluate the effacacy of minimally invasive or micro-invasive percutaneous nephrolithotomy（ MPCNL） in treating upper urinary calculi. Methods A retrospective analysis was performed on 2,724 patients received MPCNL in our department from January 2004 to December 2013. Results During the treatment,2,835 kidneys were treated and MPCNL was performed for3,078 times,including first stage procedures for 2,696 times（ 87. 59%）,secondary procedures for 357 times（ 11. 60%） and third procedures for 25 times（ 0. 81%）. Nephrolithotomy was performed in 2,786 cases（ 98. 27%） via single tract,in 44 cases（ 1. 55%） via double tracts and in 5 cases（ 0. 19%） via triple tracts. After,173 cases（ 6. 35%） needed extracorporeal shock wave lithotripsy（ ESWL） and / or flexible ureteroscope lithotripsy. The average operating time was（ 120. 4 ± 50. 5） min. The stone-free rate after MPCNL was91. 2%,and it was increased up to 94. 1% by adjunctive ESWL and / or flexible ureteroscope lithotripsy. And the mean hospital stay was（ 10. 6 ±3. 2） days. Blood transfusion was performed in 61 cases（ 2. 24%） including 8 cases（ 0. 29%） that needed selective renal arterial embolization to achieve hemostasis. Other complications included 1 case（ 0. 04%） of kidney rupture caused by nephrectomy,1 case（ 0. 04%） case of colon injury,and 5 cases（ 0. 18%） of pleura injury. Septic shock happened in 28 cases（ 1. 03%）,one of which（ 0. 04%） died. Another death was caused by pulmonary embolism seven days after operation. Conclusion MPCNL has the advantage of less invasion and complications and higher stone-free rate. The clinical experience in MPCNL demonstrates that it is safe,feasible,and efficient for managing upper urinary calculi.