14Fr单通道经皮肾镜碎石取石术治疗上尿路结石的临床研究

Clinical Study of 14Fr Single-channel Percutaneous Nephrolithotomy in the Treatment of Upper Urinary Calculi

目的:分析研讨14Fr单通道经皮肾镜碎石取石术治疗上尿路结石的临床疗效。方法:随机从某院2018年5月~2019年1月期间收治的上尿路结石患者中抽取21例肾及/或输尿管上段结石患者进行讨论,患者均接受14Fr单通道经皮肾镜碎石取石术治疗,观察分析治疗效果。结果:21例患者均接受14Fr单通道经皮肾镜碎石取石术治疗,18例为肾中盏通道取石,3例肾上盏通道取石;21例患者平均手术时间为(66.8±1.2)min,平均术中出血量约为4ml;术毕后16例留置Fr12肾造瘘管,5例无留置肾造瘘管;平均术后造瘘管拔除时间为4.5天;平均术后住院时间为5.5天。术后1例存在残留结石,结石直径均低于0.5cm,与治疗前结石直径(2.3±0.5)cm比较,差异明显(P<0.05)。患者均接受保守治疗后排出,成功率为95.23%(20/21)。术中均无中转开放手术,未发生输尿管明显损伤或穿孔;术中、术后均无大出血,无输血者;术后均无出现感染性休克。结论:14Fr单通道经皮肾镜碎石取石术治疗上尿路结石,具有低并发症、安全、微创、有效的特征,疗效突出。

Objective: To analyze the clinical effect of 14Fr single-channel percutaneous nephrolithotomy in the treatment of upper urinary calculi. Methods: 21 cases of patients with upper urinary calculi admitted to a hospital from May 2018 to January 2019 were randomly selected for discussion. All patients were received 14Fr single-channel percutaneous nephrolithotomy. The therapeutic effect was observed and analyzed. Results: All 21 patients received 14Fr single channel percutaneous nephrolithotomy, 18 patients received middle calyx lithotripsy and 3 patients received upper calyx lithotripsy. The average operation time of 21 patients was (66.8±1.2) minutes, with an average intraoperative bleeding volume about 4ml. After operation, 16 patients received Fr12 nephrostomy tube, and 5 patients did not receive indwelling nephrostomy tube. The average time for removal of the fistula was 4.5 days. The hospital stay was 5.5 days. 1 case had residual stones after operation. The diameter of stones was less than 0.5 cm. Compared with the diameter of calculi before treatment (2.3±0.5) cm, the difference was significant ( P <0.05). All patients were discharged after conservative treatment, the success rate was 95.23%(20/21). There was no conversion to open surgery, no obvious injury or perforation of ureter, no massive hemorrhage or blood transfusion during and after operation, and no septic shock after operation. Conclusion: 14Fr single-channel percutaneous nephrolithotomy in the treatment of upper urinary tract calculi has the characteristics of low complications, safety, minimally invasive and effective, and the curative effect is outstanding.