目的 探讨超声引导下斜仰卧截石位微通道经皮肾输尿管镜碎石取石术的疗效和安全性.方法 分析超声引导下斜仰卧截石位经皮肾输尿管镜碎石取石治疗上尿路结石56例的临床资料,男38例,女18例,平均(44±16.7)(23~70)岁;输尿管上段结石10例,肾结石46例(包括单个肾盂结石26侧、多发结石16侧、铸形结石11侧).结果 全部成功获得经皮肾穿刺通道.手术时间60～190 min,平均(98±40.1)min.输尿管上段结石10例单次清除率100%;肾结石单次结石清除率71.70%,结石总清除率为92.45%;平均出血量(125±44.5)mL,术中术后均无输血;无胸膜、腹腔脏器、结肠损伤.结论 超声引导下斜仰卧截石位微通道经皮肾输尿管镜碎石取石术中患者舒适、安全,可较好耐受手术,结石清除率较高,可同时处理各种异常情况,值得临床推广应用.%Objective To investigate the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy in inclined supine combined with lithotomy position under ultrasound guidance in the treatment of upper urinary calculi. Methods 56 patients with upper urinary calculi received minimally invasive percutaneous nephrolithotomy in inclined supine combined with lithotomy position under ultrasound guidance. The patients included 38 males and 18 females, aged 44 + 16. 7(23?70) years. 10 patients had upper ureteral calculi, 46 had renal calculi (including 26 single stone in pelvis, 16 multiple stones and 11 stag horn stone). Results All operations were successful. The operation time was 98 + 40.1 (60?90 minutes). 10 cases with upper ureteral calculi were stone-free after a single operation (100%). 38 patients with renal calculi were stone-free (71. 70%) after a single procedure and 11 (20.75%) were stone-free after a second procedure. The total stone clearance rate was 92.45%. Nobody needed blood transfusion and no serious complications occurred during operation. Conclusion Minimally invasive percutaneous nephrolithotomy in inclined supine combined with lithotomy position under ultrasound guidance is an effective and safe treatment method with high stone clearance rate.
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