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目的探讨微通道经皮肾输尿管镜联合气压弹道碎石取石术(mini-PCNL)在基层医院的应用疗效和安全性。方法对2010年3月-2013年3月收治的108例上尿路结石患者采用mini-PCNL予以治疗,并就手术方式、手术时间、结石清除率等情况进行分析表述。结果 107例患者成功在B型超声引导下建立经皮肾穿刺通道,1例肾下盏结石因肾脏大出血改开放手术行肾部分切除术,3例患者术中建立通道后出血较多安置肾造瘘管后行二期手术。手术时间为20~190 min,平均(78.0±40.1)min,结石总清除率78.5%,其中输尿管上段结石单次清除率100.0%、肾结石单次清除率70.1%。术中平均出血量(105.0±45.6)mL,无胸膜、腹腔脏器、结肠损伤;平均住院7~14 d。结论 mini-PCNL治疗上尿路结石具有较高的结石清除率、良好的安全性,同时具有术后恢复快、费用适中等优点,值得在基层医院推广应用。
Objective To investigate the efficacy and safety of mini-percutaneous nephroureteroscopic and mini-PCNL in primary hospitals. Methods A total of 108 patients with upper urinary tract stones who were admitted to our hospital from March 2010 to March 2013 were treated with mini-PCNL. The surgical procedures, operation time and stone clearance rate were analyzed. Results A total of 107 patients underwent percutaneous nephrostomy through B-mode ultrasound. One case of renal pelvis underwent a partial nephrectomy due to hemorrhage of the kidney. Three patients underwent hemorrhage after surgery to establish a renal graft Second postoperative fistula surgery. The operation time ranged from 20 to 190 minutes (mean, 78.0 ± 40.1) min. The total stone removal rate was 78.5%. The single ureteral stone clearance rate was 100.0% and the single stone removal rate was 70.1%. The mean intraoperative blood loss (105.0 ± 45.6) mL, no pleural, abdominal organs, colon injury; average hospitalization 7 ~ 14 d. Conclusion The mini-PCNL treatment of upper urinary tract stones with high stone clearance rate, good safety, and has the advantages of fast recovery, moderate cost, it is worth in the primary hospital promotion and application.