1120例经皮肾镜疗效分析  

Analysis of curative effect (1120 cases)

作　　者：向松涛[1] 王树声[1] 张策[1] 李源[1] 甘澍[1] 王志超[1] 

机构地区：[1]广东省中医院泌尿外科,广东广州510010

出　　处：《中国内镜杂志》2010年第4期435-437,共3页China Journal of Endoscopy

摘　　要：目的总结经皮肾镜(PCNL)的治疗经验,提高治疗水平。方法回顾性分析2003年3月～2009年6月采用PCNL治疗1120例肾、输尿管结石患者的临床资料,分析其疗效及并发症。结果 1120例患者完成手术,治疗4周后总结石清除率为95.3%,首次结石清除率为78.0%,17.3%的残余结石需进一步辅助综合治疗。早期并发症发生率32.4%,207例发热超过38℃占18.5%,75例无临床意义的出血占6.7%,5例需输血治疗占0.5%,3例需介入栓塞止血占0.3%。47例集合系统穿孔导致大量冲洗液外渗占4.2%,3例周围脏器损伤0.3%,23例尿脓毒症占2.1%,其中5例严重尿脓毒症休克占0.5%,2例死亡,总死亡率0.2%。微通道(14～16F)经皮肾镜钬激光碎石术治疗组与标准通道(22F)经皮肾镜气压弹道联合超声碎石术治疗组,结石清除率分别为:94.6%与95.9%,差异无显著性(P>0.05),并发症发生率分别为:32%与33.2%,差异无显著性(P>0.05),平均碎石取石时间分别为(73±45)min与(52±36)min,差异有显著性(P<0.01)。结论 PCNL是微创、高效的肾结石的治疗方法,微通道和标准通道PCNL疗效相当,严重的出血和感染是PCNL最凶险的并发症,而严重尿脓毒症休克是死亡的主要原因。【Objective】To summarize experience of percutaneous nephrolithotomy and improve curative level. 【Methods】1120 patients （576 males,544 females,aged 17～78 years） were treated with percutaneous nephrolitho-tomy which clinical data including curative effect and complication were retrospective analyzed between 2003 and 2009. The mean （range） stone diameter was 26 （13～52） mm.【Results】1120 cases were completed,the total stonefree rate was 95.3% within 4 weeks after PNL,and the primarily stone-free rate was 78.0%,the rate of retained calculus patients needed auxiliary measures （a second PNL,ESWL,ureterorenoscopy） was 17.3%. Overall,the early complication rate was 32.4%,fever rate was 18.5%,75 cases （6.7%） hemorrhage were clinical insignificance,5 cases （0.5%） need blood transfusion,3 csaes （0.3%） need intervention embolism,47 cases （4.2%） rinse solution extravasation were clinical significance,3 cases （0.3%） ambient organ were injured including colon and pleura ,23 cases （2.1%） were urosepsis,5 cases （0.5%） were severe urosepsis and septic shock,and 2 cases were dead,deaths total rate was 0.2%,deaths rate of severe urosepsis and septic shock was 40%,the rate of stone-free and the rate of complication were insignificant difference between microchannel and normochannel （P〈0.05）,the operation time of calculi clearance was significant difference between microchannel and normochannel （P〈0.01）.【Conclusions】Micro-injures and high-performance were proved in PCNL,therapeutic equivalence was observed between microchannel and normochannel,serious hemorrhage and infection were dangerous postoperative complications,severe urosepsis and septic shock were primary death cause.

关 键 词：肾结石 输尿管结石 经皮肾镜取石术 并发症 

分 类 号：R692.4[医药卫生—泌尿科学]