摘要
目的探讨X线引导下微通道经皮肾镜碎石取石术(mini percutaneous nephrolithotomy,MPCNL)治疗孤立肾肾结石的安全性和疗效。方法 2006年4月～2010年6月,采用C形臂X线机定位下MPCNL治疗孤立肾肾结石38例,在输尿管导管逆行造影下建立F16皮肾通道,瑞士EMS气压弹道进行一期或多期碎石、取石。结果 38例均行单通道取石,其中28例一期取石,6例因脓肾行一期穿刺引流、二期取石,3例因鹿角形结石行三期取石,1例完全鹿角形结石行四期取石。总结石清除率92.1%(35/38),3例肾盏内残余小结石(X线示直径≤0.6 cm),嘱患者随访观察。手术时间28～68 min,(45±13)min,血红蛋白平均下降16 g/L(11～30 g/L)。术后6例出现高热(体温>38.5℃),其余患者术中及术后未出现脏器损伤、大出血等严重并发症。术后住院平均5 d(2～12 d)。38例术后随访6～28个月,(18±6)个月,肾功能均恢复正常,2例分别于术后19、25个月结石复发,因患者肾功能正常,结石未引起不适,现仍在随访中。结论 MPCNL治疗孤立肾肾结石安全、有效、创伤小、术后恢复快。
Objective To investigate the efficacy and safety of minimally invasive percutaneous nephrolithotomy（MPCNL） under the guidance of X-ray in the treatment of calculi in solitary kidney. Methods From April 2006 to June 2010,38 patients with solitary kidney calculi underwent MPCNL guided by X-ray.During the procedure,retrograde urography was performed with ureteral catheter through the ureter of the diseased kidney,percutaneous nephrostomy were then carried out with a F16 channel,and EMS with ureteroscope was used in one or more sessions. Results The overall stone clearence was 92.1%（35/38）.28 patients were treated with single access in one-stage lithotripsy,10 patients underwent single access in multiple-session procedures.The operation time ranged from 28 to 68 min with a mean of（45±13） min.The mean hemoglobin drop was 16 g/L（range,11 to 30 g/L）,mean postoperative hospital stay 5 days（ranged from 2 to 12 days）.Six patients had transient fever 38.5 ℃ postoperativly.No patients had injury to the organs,or massive hemorrhage.The patients were followed up for 6-28 months with a mean of（18±6） months,during which all of them had their renal function recovered.Two cases had calculus recurrence in 19 and 25 months after the operation respectively,but showed no symptoms or abnormal renal function.These two patients are still in follow-up.ConclusionMPCNL is safe and effective for solitary kidney calculi with quick recovery.
出处
《中国微创外科杂志》
CSCD
2011年第10期921-923,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
孤立肾
肾结石
经皮肾镜碎石取石术
Solitary Kidney
Kidney calculi
Percutaneous nephrolithotomy
