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目的探讨B超引导下微创经皮肾取石术(MPCNL)治疗上尿路结石的临床效果。方法 2006年9月至2009年6月92例上尿路结石患者在B超引导下行微创经皮肾镜取石术治疗,术后输尿管内均放置双J管,所有患者均随访1～3个月。结果行MPCNL治疗的92例患者均一期单通道取石,结石清除率84.5%;手术时间(82.2±10.8)min;术中出血(102±18.6)ml;术中输血2例(2.2%),术后并发大出血1例(1.1%),经输血对症治疗后行开放手术治疗痊愈;住院时间(5.8±1.2)d;尿液转清时间(2.7±1.0)d;术后感染6例(6.5%)。有14例(15.2%)存在不同程度的结石残留,其中9例(9.8%)行二次取石,2例(2.2%)行三次取石,3例(3.3%)术后行体外震波碎石。结论超声引导下行MPCNL治疗上尿路结石具有创伤小、高效安全、术后恢复快和并发症少等优势,值得临床推广应用。
Objective To investigate the clinical effect of B-guided minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of upper urinary tract calculi. Methods From September 2006 to June 2009, 92 patients with upper urinary tract calculi underwent minimally invasive percutaneous nephrolithotomy guided by B-ultrasound. All patients underwent bilateral J-tube placement. All patients were followed up for 1-3 months month. Results The results of MPCNL treatment showed that all the 92 patients were treated with single-channel stone removal and the rate of stone clearance was 84.5%. The operative time (82.2 ± 10.8) min, intraoperative bleeding (102 ± 18.6) ml, intraoperative blood transfusion in 2 patients (2.2% (1.1%) developed hemorrhage after symptomatic treatment. The patients were cured by blood transfusion and open surgery. The duration of hospitalization was (5.8 ± 1.2) days and the time for urine clearing was (2.7 ± 1.0) days. Six patients (6.5% ). There were 14 cases (15.2%) with varying degrees of residual stones. Among them, 9 cases (9.8%) performed secondary stone removal, 2 cases (2.2%) performed stone removal three times and 3 cases (3.3%) performed extracorporeal shock wave lithotripsy. Conclusion Ultrasound-guided MPCNL has the advantages of less trauma, more efficient and safer, faster recovery and fewer complications, which is worthy of clinical application.