选择性部分无管化经皮肾输尿管镜取石术治疗上尿路结石

摘要

Objective:To explore and evaluate the feasibility,effectiveness and safety of selective part tubeless invasive percutaneous renal ureteroscope calculus removal in the treatment of upper urinary tract calculi.Method:From May 2010 to July 2014,32 eligible cases with upper urinary tract calculi received a one-stage minimally invasive percutaneous renal ureteroscope calculus removal.Percutaneous renal puncture and tract dilation were performed under C-armed fluoroscopy to establish F16 to F18 tract,followed by postoperative conventional indwelling double-J tube and catheter.Incision was only fixed pressure by dressing without suture.Result:Of the 32 operations,the bleeding volume during the operations was 30-100 ml.The operative time was 23-110 min.The average operation time was 45 min.During the operations,no blood transfusion or pleural or other adjacent organ injury occurred.Two patients of postoperative fever(>38.5 ℃) were cured after anti-infection treatment.KUB examination showed the diameter residual stone was all less than 4 mm,with no further treatment and severe complications.Postoperative hospital stay was less than 6 days.Conclusion:With strict selective procedure,part tubeless invasive percutaneous renal ureteroscope calculus removal is safe and effective with the advantage of less pain,shorter hospital stay,rapid postoperative recovery and fewer complications.%目的：探讨选择性部分无管化微通道经皮肾输尿管镜取石术治疗上尿路结石的可行性、有效性及安全性。方法：选择笔者所在医院2010年5月-2014年7月符合筛选条件32例上尿路结石，行一期微通道经皮肾输尿管镜取石术。在C臂引导下行经皮肾穿刺和扩张通道，建立F16~F18的微通道，术后仅留置双J管及尿管。术后切口不缝合，仅敷料加压固定。结果：共行选择性部分无管化微通道经皮肾输尿管取石术32例中，术中出血量30~100 ml，手术时间23~110 min，平均45 min，无输血、胸膜及邻近脏器损伤，术后发热(大于38.5℃)2例，加强抗感染治疗后治愈，复查KUB残余结石均小于4 mm，无进一步处理，术后均无严重并发症，均在6 d内出院。结论：在进行严格筛选合适患者，部分无管化微通道经皮肾输尿管镜取石术治疗上尿路结石术后患者具有疼痛轻、住院时间短、恢复快、并发症少、住院费用少等优点，是一种安全、有效方法。