摘要
目的 探讨无管化微创经皮肾镜取石术（PCNL）治疗肾和输尿管上段结石的方法、效果、安全性及优势.方法 在超声引导下对153例肾、输尿管上段结石患者行微创PCNL.术后不留置肾造瘘管,缝合穿刺口.其中男性99例,女性54例,年龄16～80岁,平均（48.7±13.9）岁.左侧上尿路结石63例,右侧85例,双侧5例.双侧结石同期手术.结石大小1.0～5.0 cm,平均（3.1±1.2）cm.结果 153例,158侧均成功建立PCNL微创通道,一期碎石,手术时间30～150min,平均（86.5±32.9）mm.144例一期结石完全清除,清除率89.5％.6例术后应用止痛药.术后住院时间3～7 d,平均（5.7±0.9）d.未出现严重并发症.结论 对于手术过程中出血不严重,视野清晰能保持顺利完成手术,超声检查无大结石残留,无需二次手术就可以实施无管化.无管化微创PCNL治疗肾和输尿管上段结石安全、有效,具有创伤小、疼痛轻、恢复快、住院时间短等优势.
Objective To investigate the clinical value of tubeless minimally invasive percutaneous nephrolithotomy （mPCNL） in the treatment of upper urinary calculi. Methods One hundred and fifty three patients with upper urinary calculi received tubeless minimally invasive percutaneous nephrolithotomy under the guidance of ultrasound. Nephrostomy tubes were not placed in any patients at the end of procedure, and sutured stoma directly. Of the total cases, 99 were male and 54 female. The age ranged from 16 to 80 years with an average of （48.7±13.9） years. The stone location was involved in the left upper urinary tract in 63 cases. Another 85 cases were in the right upper urinary tract. Uroliths of upper urinary tract involved in both sides were seen in 5 cases, who accepted operation homeochronously. Mean stone size was （3.1± 1.2）mm in diameter. Rosults All the patients were punctured successfully at one period and the stone of 144 patients were removed out through single or two passages. Mean operation time was （86.5 ±32.9）min. The total stone clearance rate was 89.5 %. Six cases required painkillers after operation The average postoperative hospital stay was （5.7±0.9） days. No serious complications occurred during or after the operation. Conclusion Tubeless technology can be applied to these patients who had less bleeding, successful completion of PCNL and residual stones-free, because they didn＇t need a secondary surgery. Tubeless minimally invasive percutaneous nephrolithotomy are safe and effective for the treatment of upper urinary calculi. It can reduce postoperative pain, hospital stay, recovery time and has tiny wound.
出处
《中华腔镜泌尿外科杂志（电子版）》
2014年第4期24-27,共4页
Chinese Journal of Endourology(Electronic Edition)
关键词
无管化
超声引导
肾结石
输尿管结石
微创手术
经皮肾镜取石术
Tubeless
Ultrasound-guided
Renal calculi
Ureteralcalculi
Minimally invasive operation
Percutaneous nephrolithotomy
