联用多种措施提高经皮肾镜取石术治疗鹿角形肾结石的清除率

摘要

目的：：总结提高经皮肾镜取石术(PCNL)治疗鹿角形肾结石的结石清除率的措施。方法：83例鹿角形肾结石术前行 CT 平扫,PCNL术时,如患侧输尿管扩张,留置两条 F5输尿管导管,术中见尿液混浊或合并多发微细结石,联用负压吸引器,用气压弹道碎石器有序碎石,手术结束前必须用C 臂复查结石残余情况,术后2~4 d 行 KUB 检查,统计结石清除率。结果：一期手术后56例鹿角形肾结石完全清除(67.5％,56/83),手术时间平均81 min(28~142 min),血红蛋白平均下降23 g/L(0~54 g/L),1例患者术后血红蛋白持续下降,行肾动脉造影＋超选择性血管栓塞术,术后发热7例,无尿源性脓毒血症发生,无周围脏器损伤,无患者死亡。结论：术前CT平扫,术中必要时留置两条输尿管导管、联用负压吸引器,有序碎石,手术结束前C臂机检查结石残余等综合措施有助提高鹿角形肾结石PCNL术的结石清除率。%Objective:To summarize the strategies of increasing the stone-free rate of staghorn calculi by per-cutaneous nephrolithotomy (PCNL).Methods:Eighty-three cases of staghorn calculi were subjected to kidney non-contrast CT (NCCT)scan preoperatively.During PCNL,two F5 ureteral catheters were indwelled when the expansion of the ipsilateral ureter was found,together with a suction device if preoperative diagnosis of urinary tract infection was done or cloudy urine or merge multiple tiny stones were found intraoperatively.Pneumatic lith-otripsy device was used to shatter stones orderly.The C-arm was used to check the residual stones before the end of operation.KUB radiography was carried out to statistically analyze the stone free-rate 2-4 days postoperation. Results:After the first stage PCNL,56 cases of staghorn calculi were removed completely (67.5%,56/83).The mean operative time was 81 min (28-142 min),and mean hemoglobin decrease was 23 g/L (0-54 g/L),In one case of postoperatively declined hemoglobin,renal arteriography and super selective embolization were done.Seven cases had fever postoperation.No urosepsis and organ inj ury occurred.There was no death.Conclusions:Kidney NCCT scan preoperation,two ureteral catheters,if necessary,together with a suction device,orderly shatter stone,the C-arm used to confirm residual stone before the end of PCNL,all of above comprehensive measures can increase the stone free-rate of staghorn calculi by PCNL.