Objective To explore the clinical effect of percutaneous nephrolithotomy ( PCNL ) for upper urinary tract lithangiuria in primary hospitals . Methods A total of 181 cases with upper urinary tract stones were treated by PCNL in our hospital from October 2011 to April 2014, including 98 cases of upper ureteral calculi and 83 cases of renal calculi .Under the guidance of B-ultrasound or X-ray, percutaneous nephrolithotomy was conducted .Channels from skin to kidney were dilated . Ureteroscopic pneumatic lithotripsy was carried out after stones were identified .A F5 double J catheter and a nephrostomy tube were placed postoperatively . Results The channels from skin to kidney were successfully established in all the 181 patients.One-stage lithotripsy was performed in 156 patients (86.2%) and a second lithotripsy was required in 22 patients (12.2%).Conversion to open surgery was required in 3 patients (1.7%) due to unsuccessful puncture .The stone free rate by PCNL was 90.6%(164/181).The residual kidney calculi occurred in 14 cases (7.7%), 10 of which (5.5%) were completely cleared by ESWL .The stone free rate by PCNL combined with ESWL was 96.1%(174/181).Follow-up was achieved postoperatively in 181 cases for 3-12 months.Only 4 cases (2.2%) had residual calculi and the remaining 177 cases (97.8%) showed free of stones under B-ultrasonography or X-ray. Conclusions The PCNL has advantages of high stone clearance , minimal invasion, and quick recovery for upper urinary tract stones . It can be used in conditional primary hospitals .%目的：探讨基层医院开展经皮肾镜取石术（ percutaneous nephrolithotomy ，PCNL）治疗上尿路结石的临床效果。方法2011年10月～2014年4月采用PCNL治疗上尿路结石181例，在B超或X线引导下经皮肾穿刺，扩张皮肾通道，寻找到结石后行气压弹道碎石术，术后常规留置F5双J管及肾造瘘管引流。结果178例均一期成功建立经皮肾通道。156例（86．2％）一期取石，22例（12．2％）二期取石，3例（1．6％）因穿刺失败改行开放手术治疗。164例（90．6％）行PCNL结石取净。14例（7．7％）肾结石残留，其中10例（5．5％）结合体外冲击波碎石术（ extracorporeal shock wave lithotripsy ，ESWL）治疗后结石排净。 PCNL联合ESWL完全清除率为96．1％（174／181）。181例术后随访3～12个月，除4例（2．2％）有结石残留外，其余177例（97．8％）B超或腹部平片显示结石完全排出。结论 PCNL治疗上尿路结石疗效确切，创伤小，恢复快，可在有条件的基层医院开展。
展开▼
