超微经皮肾镜取石术在直径1.5～2.5 cm肾及输尿管上段结石患者中的应用

Ultra-mini percutaneous nephrolithotomy for patients with 1.5 ~ 2.5 cm diameter renal and ureteral calculi

摘要:

目的 探讨超微经皮肾镜取石术（UMP）应用于直径1.5～2.5 cm肾及输尿管上段结石患者中的安全性和有效性。方法 回顾性分析2018年6月－2020年6月宿迁市第一人民医院收治的60例直径为1.5～2.5 cm肾及输尿管上段结石患者的临床资料，均采用UMP治疗，分析患者手术时间、住院时间、手术成功率、结石清除率、并发症发生率及额外镇痛药使用情况。结果 60例患者均一期建立通道并顺利完成手术。所有患者均未行单通道手术，未接受输血，无毗邻脏器损伤（肠道、肝脏和脾脏等），无血气胸发生；存在尿外渗或者有明显症状的腹膜后灌注液患者3例（5.0%），均行保守治疗好转；发热（体温高于38℃）5例（8.3%），均对症治疗后好转；无感染性休克患者。手术时间为35～98 min，平均（56.1±21.3）min；术后住院天数为3～8 d，平均（4.1±1.8）d；术后立即评估结石清除率为85.0%（51/60），术后1个月评估结石清除率为91.7%（55/60）；术后镇痛药使用率为15.0%（9/60）。结论 UMP是治疗直径1.5～2.5 cm肾及输尿管上段结石安全、有效的治疗方法之一，值得临床推广。

Abstract:

Objective To investigate the safety and effectiveness of ultra-mini percutaneous nephrolithotomy (UMP) for patients with 1.5~2.5 cm diameter renal and ureteral calculi.Methods A retrospective analysis was performed on the clinical data of 60 patients with upper ureteral calculi of 1.5~2.5 cm in diameter from June 2018 to June 2020, all the patients were treated with UMP. The operation time, hospitalization time, surgical success rate, stone removal rate, complication rate and use of additional analgesics were estimated.Results All the 60 patients in this group had a first-stage access and successfully completed the operation, none of the patients underwent single-channel surgery, all the patients did not receive blood transfusion, no adjacent organ injury (intestinal tract, liver and spleen), no pneumothorax occurred; There were 3 cases (5.0%) of urinary extravasation or retroperitoneal perfusate with obvious symptoms, all of which were treated with conservative treatment; 5 cases (8.3%) with fever (body temperature is higher than 38℃) improved after symptomatic treatment, no septic shock; The operation time was 35~98 min, with an average of (56.1 ± 21.3) min; Postoperative hospital stay was 3 ~ 8 d, with an average of (4.1 ± 1.8) d; Postoperative evaluation of stone removal rate was 85.0% (51/60), the rate of stone removal was 91.7% (55/60) in the first month after surgery; The postoperative analgesic use rate was 15.0% (9/60).Conclusions Patients with 1.5 ~ 2.5 cm diameter kidney and upper ureteral calculi, UMP is one of the safe and effective treatment methods, which is worthy of clinical promotion..