超声引导下11肋间经皮肾微造瘘碎石治疗上尿路结石117例分析

摘要

Objective To study the efficacy and safety of supracostal access for percutaneous nephrolithotomy. Methods 310 patients underwent percutaneous nephrolithotomy by the same surgeon,of whom 117 cases had a 11-12 intercostal access,193 cases had a 12 subcostal access. All patients received CT or IVP+CT scan. Data were analyzed prospectively for stone clearance rates,hospital days and postoperative complications. Results In the intercostal access and subcostal access group,the hospital days were (8. 15± 2. 13)d,(8. 36±2. 03)d,stone clearance rates were 78%(91/117) and 71% (138/193)respectively. 2 patients by subcostal access did embolization for serious bleeding. Conclusion The supracostal approach is found to be effective as well as safe.%目的 评价超声引导下肋间通道经皮肾微造瘘碎石治疗上尿路结石的疗效及安全性.方法 回顾性分析2009年5月至2011年4月由同一主刀手术医师在超声引导下行经皮肾微造瘘碎石治疗310例上尿路结石患者的临床资料.其中117例(38%)患者采用11～12肋间通道,193例(62%)患者采用12肋缘下通道,建立F 18～22肾造瘘通道.术前通过泌尿系CT三维重建或静脉尿路造影(IVP)联合双肾CT平扫检查.对患者住院时间、结石清除率、并发症发生率进行评价.结果 肋间通道与肋下通道两组患者住院时间分别为(8.15±2.13)d、(8.36±2.03)d;肋间通道结石清除率为78%(91/117),肋下通道结石清除率为72%(138/193),两组患者结石清除率比较差异无统计学意义(χ2=1.48,P=0.223);肋下通道组有4例患者术后出血行输血治疗,2例患者行选择性肾血管栓塞止血.结论 超声引导下的11肋间经皮肾微造瘘碎石治疗上尿路结石安全、有效.