一步扩张法在微创经皮肾镜取石中的应用

One-step dilation technique in minimally invasive percutaneous nephrolithotomy

摘要:

目的 探讨一步扩张法建立微创通道经皮肾镜取石术（MPCNL）治疗上尿路结石的有效性和安 全性。方法 回顾性分析2011 年2 月-2015 年3 月该院一步扩张法建立微创通道经皮肾通道治疗上尿路结 石2 813 例的临床资料。结果 2 813 例患者一步扩张，所有通道均成功建立。其中单通道取石2 383 例（84.71%）， 多通道取石430 例（15.29%）。平均通道建立时间（2.3±0.8）min，平均手术时间（78.6±41.1）min。一期手 术清石率78.59%，出院时结石清除率89.29%，术后1 个月结石清除率为91.50%。术后输血93 例，选择性肾动 脉栓塞术21 例。毗邻脏器损伤：胸膜损伤9 例，结肠损伤1 例（经保守治疗好转），尿外渗13 例，肾周血肿 15 例，无肝脾损伤。感染性休克2 例，抗感染处理后好转。结论 MPCNL 中使用一步扩张法建立通道，迅速、 安全有效，能减少X 线暴露和节约手术时间，但并不增加通道的出血风险。

Abstract:

Objective To evaluate the efficacy and safety of one-step dilation technique in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods Clinical data of 2 813 patients who underwent MPCNL by onestep dilation technique from February 2011 to March 2015 was retrospectively analyzed. Results 2 813 patients were successfully underwent MPCNL by one-step dilation, including 2 383 cases who were accessed by single tracts (84.71%) and 430 (15.29%) cases by multiple tracts. The mean operating time was (78.6 ± 41.1) min, the mean tract accessing time was (2.3 ± 0.8) min.The stone-free rate after one session operation was 78.59%. It improved to 91.50% one month after operation. During and after operation, 93 cases needed transfusion, 21 underwent selective renal artery embolization. Adjacent viscera damage: 9 cases with pleural lesions and 1 case with colon injury, 13 cases with urinary extravasation, perirenal hematoma in 15 cases, without liver and spleen injury. Septic shock in 2 cases, who was recovered after anti-infection treatment. Conclusion One-step dilation is safe and effective technique to establish tracts in MPCNL, which can reduce X-ray exposure and operation time, but does not increase the risk of bleeding.