二期经皮肾输尿管镜碎石取石术处理上尿路结石（附691例病例报告）

Two-stage percutaneous nephrolithotomy in the treatment of upper urinary lithiasis （report of 691 cases）

目的 探讨二期经皮肾输尿管镜处理上尿路结石的方法与应用价值.方法 回顾性分析本院2005年1月至2014年12月所有诊断上尿路结石并行二期经皮肾输尿管镜碎石取石术的病例,共691例,对手术时间、结石清除率、术中出血量、并发症发生率（主要指出血、脏器损伤、脓毒症、死亡等）、术后住院时间等指标进行统计分析.结果 691例患者均顺利行一期经皮肾穿刺造瘘术,二期碎石取石手术的平均手术时间为70min,一次手术及总体结石取净率分别为92.7％、96.8％,术中平均出血量为55mL,术后常见并发症发生率为大出血（1.3％）、输血（0.57％）、周围脏器损伤（0.14％）,术后患者平均住院时间为4.8d.结论 二期经皮肾输尿管镜碎石取石术在手术时间、结石清除率、术中出血量、术后并发症发生率、术后住院时间等方面具有安全、高效的特点,是值得推广的手术方式.

Objectives To discuss the methods and application value of the two-stage percutaneous nephrolithotomy （PCNL） for upper urinary lithiasis.Methods 691 patients with upper urinary tract calculi who underwent the two-stage PCNL in our hospital from January 2005 to December 2014 were retrospectively analyzed.The data of the operation time,stone clearance rate,intraoperative blood loss,the rate of complication （including of hemorrhage,peripheral viscera injury,sepsis,and death） and postoperative hospital stay were analyzed.Results The renal puncture fistula for all the patients was successfully completed.The average operation time for the second-stage was 70 min.The one-time stone clearance rate and the total stone clearance rate was 92.7% and 96.8%,respectively.The intraoperative blood loss was 55 mL.The rate of complication was massive hemorrhage （1.3%）.Blood transfusion （0.57%）,peripheral viscera injury （0.14%）.The average postoperative hospital stay was 4.8 d.Conclusions The two-stage PCNL has obvious advantage on aspects of operation time,stone clearance rate,intraoperative blood loss,the rate of complication and the postoperative hospital stay.It is worthy of clinical application.