摘要
目的:探讨留置输尿管外支架的无管化经皮肾镜取石术(tubeless percutaneous nephrolithotomy,tubeless PCNL)的安全性和有效性。方法:回顾性分析43例留置输尿管外支架的tubeless PCNL治疗肾或输尿管上段结石的患者资料。男23例,女20例,平均年龄44.9岁。其中肾盂结石22例,输尿管上段结石18例,肾多发性结石3例。结石最大径为(2.4±1.1)cm。合并患肾轻度积液4例,中度积液21例,重度积液18例。在经皮肾镜取石术结束时,通过B超和C臂X线证实结石已经完全清除,然后把逆行插入的输尿管导管的头端调整至肾盂的中央,让扩张鞘退至肾造瘘通道以外,证实瘘道无活动性出血,最后拔除扩张鞘,并用丝线缝合皮肤伤口。结果:43例患者,其中41例结石完全清除,2例为无意义残留结石。手术时间30～75min,平均45min。手术引起血红蛋白平均下降6.5g/L。术后第1天视觉疼痛评分为(3.0±1.4)分。术后平均住院天数为3d。术后出现急迫性尿失禁1例,肾周血肿1例,发热2例,持续性肉眼血尿2例,轻度尿外渗2例。结论:在严格掌握手术适应证的前提下,留置输尿管外支架的tubeless PCNL是安全和有效的。
Objective：To review the safety and efficacy of tubeless percutaneous nephrolithotomy （tubeless percutaneous nephrolithotomy, PCNL） with a ureteral catheter. Method： From May 2010 to Dec 2011, 43 cases （23 males and 20 femals, mean age of 44. 9 years） of renal or proximal ureteral calculi treated by tubeless PCNL with a ureteral catheter were reviewed. There were 22 cases with renal pelvic calculi, 18 cases with upper ureteral calculi, 3 cases with multiple renal calculi. The stone burden was （2.4±1.1） cm. Of 43 cases, mild hydronephrosis was found in 3 cases, moderate hydronephrosis in 21 cases, and severe hydronephrosis in 18 cases. At the end of the procedure of PCNL, the calculi were cleared under the monitoring of C-armed fluoroscopy and B-ultrasound. The head end of the ureteral catheter was adjusted in the center of renal pelvis. The peel-away sheath was removed when no active bleeding was confirmed. Result：Of 43 cases, stone-free was found in 41 cases, and insignificant residual stone in 2 cases. The average operative time was 45 （30-75） rain. The mean hemoglobin drop was 6.5 （3- 10） g/L. The visual analogue score on the first postoperative day was （3.0±1.4）. The average postoperative hospital stay was 3 days. The complications included one urge incontinence, one perirenal hematoma, one postoperative fever, two persistent macrohematuria, and two mild urinary extravasation. Conclusion： Under the premise of strict surgical indications, tubeless PCNL with a ureteraI catheter was safe and effective for the treatment of upper urinary calculi.
出处
《临床泌尿外科杂志》
2013年第4期295-297,共3页
Journal of Clinical Urology
基金
广东省科技计划项目(编号2011B061300039)
