B超引导下经皮肾镜碎石清石术治疗肾、输尿管上段结石的临床观察与并发症处理

Clinical observation and complication management of standard channel percutaneous nephrolithotripsy with pneumatic and ultrasonic power under B-type ultrasound guidance in management of renal and upper ureteral calculi

目的探讨B超引导穿刺的24F标准通道PCNL治疗肾、输尿管上段结石（L4以上）的治疗效果。方法使用回顾性分析的方法针对我院2008年12月至2012年12月175例肾、输尿管上段结石（L4以上）的病人采用标准通道PCNL治疗的相关资料。结果本组所有病人均顺利在B超引导下穿刺建立通道,其中150例病人接受一期PCNL治疗,25例病人接受二期PCNL治疗,手术时间约80~180 min,平均约130 min;术后平均住院天数约8天;术后总清石率为91%;术后并发症23例,包括出血6例（其中术中术后接受输血病人1例）,感染发热5例,术后恶性高血压1例,血气胸4例,泌尿系损伤穿孔2例,灌注液外渗5例。结论 B超引导的标准通道PCNL术式安全有效,是治疗肾、输尿管上段结石的较好方法。

Objective To evaluate the clinic efficacy and safety with PCNL under B-type ultrasound guidance in management of renal and upper ureteral calculi. Methods The clinical date of 175 cases treated by standard channel PCNL were analyzed retrospectively. Results The punctures were completed successfully in all cases, and 150 of 175 cases were performed in one-session, 25 cases were performed successfully in two-session. The mean operation time was 130 （80 to 180） mins, and the mean hospital stay was eight days. The stone-free rate was 91%. Postoperative complications were seen in 23 PCNL, included postoperative bleeding in 6 （1 case needed transfusion during and after operation）, fever in five, malignant hypertension in one, hemopneumothorax in four, urinary injury in two, perfusion fluid extravasation in five. Conclusion Standard channel PCNL with pneumatic and ultrasonic power under B-type ultrasound guidance is a safe and effective procedure in management of renal and upper ureteral calculi.