以上极或下极肾盏为穿刺目标肾盏的经皮肾镜碎石术  

Percutaneous Nephrolithotomy Aimed at Upper or Lower Calices

作　　者：张建军[1] 金讯波[1] 于江[1] 李斌[1] 

机构地区：[1]山东大学附属省立医院泌尿微创中心,山东济南250021

出　　处：《泌尿外科杂志（电子版）》2010年第4期17-19,共3页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨以上极或下极肾盏为穿刺目标肾盏的经皮肾镜碎石术治疗复杂性肾结石的可行性及手术经验。方法 2005～2010年行超声引导下的经皮肾镜碎石术治疗复杂性肾结石224例,对其临床资料进行了回顾性分析。其中,男106例,女118例。完全性鹿角结石68例,部分鹿角结石74例,多发结石82例。将患者分为二组,以中后组肾盏或肾盂为穿刺目标组104例,术中第一穿刺目标肾盏均选择中后组肾盏或肾盂;以上极或下极肾盏为穿刺目标肾盏组120例,术中第一穿刺目标肾盏均选择上极或下极肾盏。所有患者经第一经皮肾通道清除大部分结石后再根据需要一期或二期建立第二、第三或第四经皮肾通道。结果所有患者均在一期或二期手术后完成治疗,术中、术后未发生严重并发症,以中后组肾盏或肾盂为穿刺目标组部分患者术后配合行体外冲击波碎石。其中,以中后组肾盏或肾盂为穿刺目标组104例,结石取净80例,结石取净率77%,总手术时间125～260min,平均186min,住院17～28天,平均住院25天;以上极或下极肾盏为穿刺目标肾盏组120例,结石取净109例,结石取净率91%,总手术时间110～210min,平均154min,住院11～26天,平均住院18天。结论以上极或下极肾盏为穿刺目标肾盏的经皮肾镜碎石术能显著提高复杂性肾结石的结石取净率。Objective To evaluate the feasibility of ultrasonography-guided percutaneous nephrolithotomy (PCNL)aimed at upper or lower calices for the complicated renal calculi.Methods We retrospectively analysed the clinical data of 224 cases(106 males and 118 females)of complicated renal calculi underwent ultrasonography-guided PCNL from 2005 to 2010.In these 224 cases,68 had complete staghorn calculi and 74 had partial staghorn calculi,while 82 had multiple calculi.The patients were divided into two groups,120 cases (group 1)treated by PCNL aimed at upper or lower calices,and the other 104 cases(group 2)treated by PCNL aimed at the pelvis.After major calculi was removed by tract 1,more PCNL tracts might be made during the following operation.Results All treatments were finished in stage 1 or stage 2.There was no serious complication intraoperatively or postoperatively.Some patients of group 2 underwent ESWL to remove residual stone.In the 104 patients who were treated by PCNL aimed at the pelvis,the stone was removed completely in 80 patients, and the stone clearance rate was 77%,median operative time were 186 minutes(range from 125 to 260 minutes),median length of hospital stay were 25 days(range from 17 to 28 days),while patients in group 1, the stone was removed completely in 109 patients,and the stone clearance rate was 91%,median operative time were 154 minutes(range from 110 to 210 minutes),median length of hospital stay were 18 days(range from 11 to 26 days).Conclusions Stone clearance rate could be significantly improved with PCNL aimed at upper or lower calices.

关 键 词：肾结石 经皮肾镜碎石术 

分 类 号：R699[医药卫生—泌尿科学]