摘要
目的探讨采用微穿刺PCNL治疗肾脏复杂性结石的安全性和有效性.方法 2001年3月-2004年10月,作者采用微穿刺PCNL治疗肾脏复杂性结石62例.在X线引导下穿刺患肾中盏,也可根据需要穿刺其他肾盏.扩张后置入14.0-18.0 F套鞘.采用8.9 F输尿管硬镜,直视下配合气压弹道碎石机将结石粉碎,一次或分次清除结石.必要时术后辅助ESWL.结果该组中,66.1%(41/62)的病例可通过一次手术基本上将结石清除.27.4%(17/62)的病例接受了2次取石术.平均手术(172±44)min.25.8%(16/62)的病例术后或2次手术之间接受了ESWL治疗.3个月后随访,结石清除率为82.0%.主要合并症包括:术中大出血4例(6.5%),伤口尿漏4例(6.5%),液气胸3例(4.8%).结论采用微穿刺PCNL治疗肾脏复杂性结石,具有创伤小、安全、并发症少、恢复快等优点,操作熟练、技术改进以及辅助ESWL可以大大提高手术清除结石效率,减少残留结石.
[Objective]To evaluate the application of mini-PCNL for treatment of renal complicated calculi. From March 2001 to October 2004, we treated 62 cases of complicated calculi with mini-PCNL. Under fluoroscopic guidance, the kidney were punctured, mainly through the midkidney calix, the other caliceal accesses were also feasible if needed. After dilating the access, a 14.0 F or 18.0 F peelaway sheath was inserted. An 8.9 F ureteroscopy and lithoclast were used to fragment complicated calculi. Sandwich therapy and multiple percutaneus accesses have been advocated if necessary. 66.1% of all cases basically showed stone-clear up in one-session of mini-PCNL. 27.4% of cases were treated with two sessions. The average operation time was (172±44) minutes. 25.8% of cases received ESWL after or between two sessions of mini-PCNL. In three months follow-up, the overall stone-free rate was 82.0%. The complications were noted,including major blood loss (6.5%), urinary fistula(6.5%), pneumohydrothorax (4.8%). [Conclusions] Mini-PCNL is a good and safe option for renal complicated stone treatment. With the technical improvements and ESWL, it will further the operation efficiency and stone-free rate.
出处
《中国内镜杂志》
CSCD
北大核心
2005年第4期368-369,371,共3页
China Journal of Endoscopy
关键词
肾脏结石
手术
经皮肾穿刺取石术
renal calculi
operation
percutaneous nephro lithotripsy
