微创经皮肾镜钬激光联合气压弹道碎石术治疗肾、输尿管上段结石(附1870例报道)

摘要

Objective To evaluate the clinical efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) with holmium laser and pneumatic lithotripsy treatment on renal and upper ureteral calculi.Methods From August 2007 to May 2012,our hospital treated 1870 cases of renal and upper ureteral calculi,including 42 cases of Staghorn stones,58 cases of multiple kidney stones,5 cases of sponge kidney,3 cases of renal diverticular calculi,1365 cases of single renal calculi,and 397 cases of upper ureteral calculi.MPCNL was given by the assistance of ultrasound.Results 1868 patients were successfully established percutaneous nephrolithotomy channels,including the establishment of 22 cases with 2 channels,3 cases with 3 channels of first-stage percutaneous nephrolithotomy channels.Two cases failed to establish channels; 43 cases underwent the second-stage kidney stone destruction and 11 cases received third-stage kidney stone destruction.Operation time was from 25 to 120 min,with an average of 55 min.The first-stage stone clearance rate was 90.5％ (1693/1870).36 patients suffered from postoperative fever (temperature ＞39℃),including 19 cases of positive blood culture results,2 cases of pleural injury,which recovered one week after closed thoracic drainage treatment was given,and 13 cases of heavy postoperative bleeding,which was treated with superselective renal artery embolization.217 cases were lost contact of and all the other 1653 cases were followed up for 5 to 40 months with an average of 15 months,and 76 cases(4.6％) of stone recurrence were observed.Conclusion Besides being highly effective and safe,MPCNL for renal and upper ureteral calculi has the advantage of rapid recovery with minor complications.Therefore,it is worthy of wide clinical application.%目的 评价B超引导下建立微通道行经皮肾镜钬激光联合气压弹道碎石术(MPCNL)治疗肾、输尿管上段结石的疗效. 方法 2007年8月～ 2012年5月,治疗肾、输尿管上段结石1870例,其中鹿角状结石42例,肾多发结石58例,海绵肾结石5例,肾憩室结石3例,肾脏单发结石1365例,输尿管上段结石397例.均在B超引导下行MPCNL. 结果 1868例成功建立经皮肾通道,其中22例一期建立2个通道,3例一期建立3个通道；2例建立通道失败.43例行二期碎石,11例行三期碎石.手术时间25～120 min,平均55 rin.一期结石清除率90.5％(1693/1870).36例术后高热(体温＞39℃),其中19例血培养阳性；2例胸膜损伤,留置胸腔闭式引流1周治愈；13例术后大出血,行超选择性肾动脉栓塞治疗.217例失访,1653例随访5～40个月,平均15个月,76例(4.6％)结石复发. 结论 B超引导下建立微通道行经皮肾镜钬激光联合气压弹道碎石术治疗肾、输尿管上段结石疗效确切,安全、微创,术后并发症可控,值得临床广泛应用.