摘要
目的评价无管化的微创经皮肾镜取石术治疗输尿管上段大体积结石的安全性和可行性。方法自2008年08月至2009年09月,连续的47例直径大于1.0 cm的输尿管上段结石患者,接受了一期微创经皮肾镜下钬激光碎石取石术。手术采用全麻,经皮肾穿刺和通道扩张在超声引导下进行,建立16～18 F的通道,取石后常规留置双J管。结果 47例患者均手术成功,其中45例术后未留置肾造瘘管,列入研究组进行统计。施行无管化微创经皮肾镜的45例患者,平均手术时间48.18±8.25 min,术前术后血红蛋白分别为13.42±1.91 g/dl,12.65±1.78 g/dl,无输血病例,无胸膜损伤,无其他临近脏器损伤。结石清除率为95.6%。无术后严重感染(T>38.5℃)病例,无术后明显尿外渗。术后需要镇痛药物的患者2例,术后平均留置导尿管26.08±5.54 h,术后平均住院2.54±0.66 d。结论无管化微创经皮肾镜取石术治疗输尿管上段大体积结石,安全有效、患者术后恢复快、疼痛不适少、并发症少。
Objective PCNL is regarding as the gold standard in the treatment of large proximal ureteral calculi comparing shock-wave lithotripsy and ureterorenoscopy lithotripsy,but it also has some disadvantages as longer hospital stay and analgesic use secondary to the maintance of nephrostomy tube.The aim of this study was to evaluate the safety and feasibility of tubeless minimally invasive percutaneous nephrolithotomy for the treatment of large proximal ureteral stones.Methods From August 2008 to September 2009,consecutive 47 cases of upper ureteral calculi with diameter greater than 1.0 cm,received a minimally invasive percutaneous endoscopic holmium laser lithotripsy in our surgical group.Surgery with general anesthesia,percutaneous renal puncture and tract di-lation was performed under ultrasound to the establishment of 16-18 F tract,conventional indwelling double-J tube after fragment.Results 47 patients were successful operation,including 45 cases of postoperative not indwelling renal tube was included in study group statistics.Of the 45 patients with tubeless minimally invasive percutaneous nephrolithotomy,the average operative time was 48.18±8.25 min,the preoperative and postoperative hemoglobin decrease was 0.77±0.74 g/dl,no blood transfusion needed,with no pleural and other adjacent organ injury occurred.Stone clearance rate was 95.6%.There was no postoperative severe infection（T38.5 ℃） case,with no significant postoperative extravasation occurred.Two patients required postoperative analgesic drugs,and the average of catheter indwelling was 26.08±5.54 hours,mean postoperative hospital stay was 2.54±0.66 days.Conclusions Treatment of large proximal ureter stone with tubeless minimally invasive PCNL is safe and effective in patients with rapid postoperative recovery,less pain and discomfort,and less serious complications.
出处
《中华腔镜泌尿外科杂志（电子版）》
2010年第4期4-7,共4页
Chinese Journal of Endourology(Electronic Edition)
关键词
经皮肾镜取石术
无管化
输尿管结石
微创手术
Percutaneous nephrolithotomy Tubeless Ureteral calculi Minimally invasive operation
