B超引导经皮肾镜多手段碎石术治疗上尿路结石172例疗效观察

摘要

目的 评价B超引导下经皮肾镜多手段碎石术治疗上尿路结石的临床疗效及安全性.方法 选取采用B超引导下经皮肾多手段碎石术治疗的172例183侧上尿路结石患者,回顾性分析手术的穿刺成功率、手术时间、结石清除率、手术并发症等临床资料.结果 所有患者均成功建立F16-20微通道或F24经皮肾通道Ⅰ期碎石,平均手术时间82.3 min,本组未出现气胸、肠道损伤等手术并发症,因出血严重行超选择性肾动脉栓塞治疗2例,脓毒血症1例.经多手段治疗后,术后复查KUB平片,171侧肾脏结石清除干净,净石率为93.4％,12侧肾脏有结石(＜2 cm)残留,随访1～6个月,无严重手术并发症.结论 B超引导下经皮肾多手段碎石术处理上尿路结石具有高效、安全的特点,值得临床推广应用.%Objective To evaluate the efficacy and safety of percutaneous nephrolithotripsy (PCNL)with multi-method lithotripsy under B-type ultrasound guidance for the treatment of upper urinary tract stones.Methods From September 2010 to October 2012,183 renal units of 172 patients of upper urinary tract stones underwent PCNL with multi-method lithotripsy under B-type ultrasound guidance.The clinical data of puncturing success rate,operation time,clearance rate and major complications were analyzed retrospectively.Results There were 183 tracts established,including 154 tracts of 16F-20,and 39 tracts of 24F.Two cases needed selective renal arterial embolization to achieve hemostasis,1 case of sepsis,with no case of pleura injury and colon injury.The average time for whole surgery was 83 min and the time for complete stone clearance was 64 min.The stone clearance rate was 93.4％,and 12cases had a residual stone smaller than 2 cm due to inaccessible location.No severe complications occurred during percutaneous nephrolithotripsy after 1～6 month of follow-up.Conclusion Percutaneous nephrolithotripsy with multi-method lithotripsy appears to be efficacious and safe for disintegrating and removing upper urinary tract stones under B-type ultrasound guidance.