超微创单通道经皮肾镜取石术治疗不复杂结石的临床分析

Clinical analysis of single-channel micro-percutaneous nephrolithotomy in treatment of uncomplicated ureteral calculi

摘要:

目的??探讨超微创单通道经皮肾造瘘碎石取石术（micro-PCNL）治疗不复杂泌尿系结石的可行性及优缺点。方法?回顾性分析2015年6月-2016年5月该院收治的直径<3.0 cm肾结石、输尿管上段结石体外冲击波碎石（ESWL）失败者、输尿管软硬镜碎石失败者共126例。于彩超引导下穿刺建立通道，并采用micro-PCNL（F10～F14）经皮肤肾造瘘在短输尿管肾镜（狼牌F4.5～F6.5、F6.0～F7.5，315 mm）下，用气压弹道碎石或钬激光碎石取石。对一期结石清除率、手术时间、术中出血量、住院时间及手术并发症等临床资料进行分析。结果?126例患者中一期结石清除率88.9%，6例残余结石二期取净，5例术后残余结石配合体外冲击波治疗，3例一期两通道碎石。手术时间15～75 min，平均（38.0±12.0）min。术后出血量约15～35 ml，无1例输血。住院时间5～10 d，平均7.5 d。3例因术中出血影响手术视野而采用气囊造瘘管压迫止血二期取石顺利，所有患者中未发生大出血、气胸、肠管及其他脏器损伤等并发症。结论?micro-PCNL治疗不复杂泌尿系结石相对更安全，效果更好，值得临床推广应用。

Abstract:

Objective?To evaluate the efficacy, advantages and shortcomings of micro-percutaneous nephrolithotomy in treatment of uncomplicated ureteral calculi.?Methods?Clinical data were collected from 126 patients with a failure treatment of history by ESWL (extracorporeal shock wave lithotripsy) and RIRS (retrograde intrarenal surgery) in treatment of upper ureteral calculi (< 3.0 cm) from June 2015 to May 2016. Antegrade percutaneous access was obtained by B-type ultrasound guidance. Micro-PCNL was done using YAG laser fiber or pneumatic through the ureteroscope (F4.5 ~ F6.5、F6.0 ~ F7.5, 315 mm) to disintegrate the stones. The calculi clearance rate, operation time, operative hemorrhage, length of hospital stay and complications of the patients were analyzed after operation. ?Results?The calculi clearance rate was 88.9%, the operation time was 15 ~ 75 min, the operative hemorrhage was 15 ~ 35 ml, the length of hospital stay was 5 ~ 10 d. Only one patient need the second stage surgery because of intraoperative hemorrhage affected the surgical field. No patients occurred massive hemorrhage, pneumothorax, bowel and other complications such as organ damage.?Conclusion?Micro-PCNL had a good clinical curative effect and security in treatment of uncomplicated ureteral calculi, which was worthy of promoting clinically.