超声引导下经皮肾镜超声碎石取石术治疗成人复杂性上尿路结石疗效观察

Effect of ultrasound-guided percutaneous nephrostolithotomy in the treatment of complicated upper urinary tract calculi in adult

目的探讨超声引导下经皮肾镜超声碎石取石术(PCNL)治疗成人复杂性上尿路结石的临床效果。方法回顾性分析2009年1月至2015年1月于驻马店市中心医院行超声引导下PCNL的413例复杂性上尿路结石患者的临床资料,观察其临床疗效及并发症。结果 413例患者,单通道取石355例,双通道取石58例;平均手术时间(40.0±16.2)min,平均住院时间(9.3±2.6)d;一期结石清除率为64.16%(265/413),总结石清除率为82.08%(339/413)。术中碎石致肾盂穿孔8例,术中肾盏颈撕裂出血37例,术后体温>38.5℃15例,穿刺通道出血3例,继发出血17例,均经对症处理后痊愈。结论超声引导下PCNL治疗成人复杂性上尿路结石具有微创、高效、结石清除率高、术后恢复快等优点。

Objective To investigate the clinical effect of ultrasound guided ultrasound-guided percutaneous nephrostolithotomy（PCNL） in the treatment of complicated upper urinary tract calculi in adults. Methods Clinical data of 413 patients with complicated upper urinary tract calculi who underwent ultrasound-guided PCNL in the Central Hospital of Zhumadian City from January 2009 to January 2015 were analyzed retrospectively. The curative effect and complications were observed. Results Among the 413 patients, single channel lithotripsy was performed in 355 cases, and double channel lithotripsy was performed in 58 cases. The mean operation time was （40.0 ± 16.2 ） minutes, and the average hospitalization time was （9.3 ± 2.6） days. The one-stage stone clearance rate was 64.16% （265/413）, and the total stone clearance rate was 82.08% （339/413）. The complications included 8 cases of renal pelvic perforation caused by lithotripsy, 37 cases of kidney calices neck laceration bleeding, 15 cases of postoperative body temperature than 38.5 ℃ ,3 cases of puncture channel bleeding, and 17 cases of sec- ondary bleeding. The complications were cured after symptomatic treatment. Conclusion Ultrasound-guided PCNL in the treatment of upper urinary tract calculi has the characteristics of minimally invasive, high efficiency, high stone clearance rate, fast postoperative recovery and so on.