超细经皮肾镜取石术治疗肾和输尿管上段结石的疗效观察（附32例报告）

Ultra-mini percutaneous nephrolithotomy for the treatment of renal or upper ureteral stones （report of 32 cases）

目的 探讨超细经皮肾镜取石术治疗肾和输尿管上段结石的疗效及安全性.方法 回顾性分析2015年6-10月我院32例行超细经皮肾镜取石术的肾和输尿管上段结石患者的临床资料.其中肾结石29例,输尿管上段结石3例.单发结石21例,多发结石7例,铸型结石4例.结石位于 肾下盏8例,肾盂10例,输尿管上段3例,肾盂合并下盏10例,肾盂合并上盏1例.结石大小10～41 mm,平均（20.1 ±7.6）mm;结石CT值520 ～ 1550Hu,平均（1125.9±225.9） Hu.无肾积水16例,轻度肾积水13例,中度肾积水2例,重度肾积水1例.1例合并重复肾输尿管畸形,1例为腹腔镜下肾盂切开取石术后残留结石.结果 32例均经单通道行超细经皮肾镜取石术.其中,经中盏穿刺9例,经下盏穿刺23例;经第11肋间穿刺4例,经第12肋下穿刺28例.手术时间10 ～ 90min,平均（30.3±15.0）min;术后住院天数1～5d,平均（1.9±1.0）d;血红蛋白下降1～46g/L,平均（14.6±8.4）g/L;术后止痛药的使用率为0.围手术期并发症发生率为3.13％ （1/32）,1例术中集合系统穿孔,无发热、严重出血、尿外渗、胸膜损伤等并发症发生,无输血病例.术后第1天评估结石清除率为93.75％（30/32）,术后1个月为96.88％（31/32）.结论 超细经皮肾镜取石术是治疗肾和输尿管上段结石安全、有效的方法,尤其适用于＜2 cm肾下盏结石,结石清除率高,微创、术后完全无管化,恢复快,住院时间短,大大提高了患者的生活质量.

Objective To investigate the efficacy and safety of ultra-mini percutaneous nephrolithotomy for the treatment of renal or upper ureteral stones.Methods The data of 32 patients diagnosed as renal or upper ureteral stones were retrospectively reviewed,who underwent ultra-mini percutaneous nephrolithotomy from June to October,2015,including 29 kidney stones,3 upper ureteral stones,of which 21 single stone,7 multiple stones,and 4 staghorn stones.There were 8 cases with inferior calyx stones,10 with renal pelvis stones,3 with upper ureteral stones,10 with renal pelvis stones plus inferior calyx stones and 1 with renal pelvis stones plus upper calyx stones.The mean stone size was （20.1 ±7.6） mm （ranging from 10 to 41mm）.The mean Hounsfield unit （HU） was （1 125.9 ±225.9） Hu （ranging from 520 to 1 550Hu）.In this cohort,13 cases had mild hydronephrosis,2 moderate hydronephrosis,1 severe hydronephrosis while no hydronephrosis identified in the other 16 patients.One case had concomitant kidney and ureter duplication malformation,and 1 case had residual stones after laparoscopic nephrolithotomy.Results All of the patients were treated by single tract UMP.Among them,middle calyceal puncture was performed in 9 cases,and the other 23 cases underwent lower calyceal puncture,including 4 cases of intercostal puncture,and 28 subcostal puncture.The mean operating time was （30.3 ± 15.0） min （ranging from 10 to 90 min）.The mean postoperative hospital stay was （1.9 ± 1.0）days （ranging from 1 to 5 days）.The mean hemoglobin decrease was（14.6 ±8.4）g/L （ranging from 1 to 46 g/L）.No analgesics were used.Peri-operative complication rate was 3.13% （1/32） with 1 case of collection system perforation.There was no fever,severe bleeding,urinary extravasation,pleural injury,or blood transfusion.The SFR was 93.75% （30/32） and 96.88% （31/32） on the first day and the first month after the operation,respectively.Conclusions UMP could be a safe and effective method for the treatment of renal or upper ureteral stones,especially for inferior calyceal stones less than 2cm.It offers high stone clearance rate,minimally invasiveness,quick recovery,short length of hospital stay and improved quality of life.