摘要
目的总结经皮肾微造瘘输尿管镜碎石术(MPCNL)综合其它技术治疗复杂性上尿路结石的临床经验。方法回顾性分析2002年6月至2004年11月采用MPCNL结合经皮肾造瘘术、ESWL、URL和开放手术等方法治疗复杂性上尿路结石73例患者资料。分析其病史特点、综合治疗方法、并发症和结石取净率等临床资料。73例患者,男43例,女30例,平均45岁。均为肾铸形结石或多发结石。结果Ⅰ期治疗结石排净率71.2%(52/73),Ⅱ期治疗排净率61.9%(13/21),结石总排净率89.1%(65/73)。并发症:发热12例(16.4%),术中大出血8例(10.9%),术后继发大出血3例(4.0%),尿外渗7例(9.6%),肾盂,输尿管穿孔3例(4.0%)。平均住院天数17.6d。MPC-NL结合ESWL15例(20.5%),开放手术结合MPCNL5例(6.8%),术前结合肾造瘘术治疗28例(38.4%),术中结合URL治疗26例(35.6%)。结论复杂性上尿路结石的综合治疗需制定个体化方案,MPCNL结合其它微创技术治疗复杂性上尿路结石有利于减少损伤,降低并发症,提高碎石取石效果。
Objective To summarize the clinical experience of mini-puncture percutaneous nephrostomy lithotripsy （MPCNL） in combination with other microinvasive techniques for the treatment of complex upper urinary tract calculi. Methods This series included 73 patients （43 men and 30 women;mean age, 45 years） with complex upper urinary tract calculi （staghorn or multiple calculi） who underwent MPCNL in combination with percutaneous nephrostomy, ESWL, URL and open surgery from June 2002 to November 2004. The clinical data, including medical history characteristics, combination therapies, curative effects and complications,were retrospectively analyzed. Results The complete expelling rate of the stones at stage Ⅰ treatment was 71.2% （52/73） ;the rate at stage Ⅱ treatment was 61.9% （ 13/21 ）. The overall rate of stone expelling was 89.1% （65/73）. Complications included the following： fever in 12 cases （ 16.4% ） ,intraoperative massive hemorrhage in 8 （10.9%） ,postoperative massive hemorrhage in 3 （4.0%） ,urinous infiltra-tion in 7 （9.6%） , perforation of the renal pelvis and ureter in 3 （4.0%）. The mean hospital stay was 17.6 d. Of the 73 cases,15 （20.5%） underwent MPCNL in combination with ESWL;5（6.8% ）,MPCNL with open surgery; 28 （38.4%） , MPCNL with nephrostomy preoperatively; 26 （35.6%） , MPCNL with URL intraoperatively. Conclusions Combination therapeutic regimen for complex upper urinary tract calculi should be individualized. MPCNL in combination with other microinvasive techniques is helpful for reducing injury and complications, and improving the stone-free rate.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第8期539-541,共3页
Chinese Journal of Urology
