B超引导下微创经皮肾镜碎石术治疗肾盏结石  

B-ultrasonography-guided Minimally Invasive Percutaneous Nephrolithotomy for the Treatment of Renal Caliceal Calculi

作　　者：涂响安[1] 梁辉[1] 王文卫[1] 赵亮[1] 邓立文[1] 赵良运[1] 曾令友[1] 

机构地区：[1]中山大学附属第一医院黄埔院区泌尿外科,广州510700

出　　处：《中国微创外科杂志》2010年第5期426-428,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的评价B超引导下微创经皮肾镜碎石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗肾盏结石的疗效。方法2004年7月～2008年8月,46例肾盏结石（包括16例肾上盏结石,30例肾下盏结石）在B超引导下行MPCNL,结石平均直径2.2cm（1.6～3.1cm）,右侧20例,左侧26例。36例有轻度肾积水。8例曾行肾切开取石术。24例曾行1～3次体外震波碎石术（ESWL）。36例应用EMS气压弹道探针,10例插入600μm钬激光光纤,将结石击碎。结果结石清除率为91.3%（42/46）,平均手术时间85min（60～150min）,平均出血120ml（50～250ml）,平均住院时间12d（8～25d）。4例残余结石者辅助1～2次ESWL治疗。2例术后7～14天出现迟发性肾大出血,经选择性或超选择性肾动脉栓塞而止血。30例术后随访6～50个月,平均23个月,未见结石复发。结论B超引导下MPCNL治疗肾盏结石具有简单、安全、创伤小、成功率高等优点。Objective To evaluate the efficacy of minimally invasive percutaneous nephrolithotomy（MPCNL）under the guidance of B-ultrasonography for patients with renal caliceal calculi.Methods From July 2004 to Aug 2008,MPCNL guided by B-ultrasonography was performed on 46 cases of renal caliceal calculi,including 16 upper and 30 lower calyx calculi.The average diameter of the calculi was 2.2 cm（ranged from 1.6 to 3.1 cm）.Among the patients,the calculi were located at the right side in 20 cases,and the left side in 26.Before receiving MPCNL,36 cases had mild hydrocalycosis,8 cases had undergone open nephrolithotomy,and 24 cases had been treated by extracorporeal shock wave lithotripsy（ESWL）for one to three times.In our patients,36 cases received pneumatic lithotripsy by EMS,and 10 were treated by using holmium laser（600-μm fiber）.ResultsThe clearance rate was 91.3%（42/46）,and mean operation time was 85 min（ranged from 60 to 150 min）.During the operation,the mean blood loss was 120 ml（50 to 250 ml）.The patients were discharged from hospital in 8 to 25 days with a mean of 12 days.Four of the cases received re-operation by ESML for one or two times because or residual stones;and delayed massive hemorrhage in the kidney was detected in two cases 7 to 14 days after the surgery,they were then cured by selective embolization.Thirty of the patients were followed up for 6 to 50 months（mean,23 months）,during the period,no recurrent calculi were revealed.Conclusions B-ultrasonography-guided MPCNL is safe,effective and minimally invasive for patients with renal caliceal calculi.

关 键 词：肾结石 经皮肾镜碎石术 

分 类 号：R692.4[医药卫生—泌尿科学]