微创经皮肾镜碎石术治疗输尿管上段嵌顿结石  

Minimal Invasive Percutaneous Nephrolithotomy for Impacted Upper Ureteral Calculi

作　　者：赵福军[1,2] 阮渊[1,2] 鲁军[1,2] 夏术阶[1,2] 

机构地区：[1]上海交通大学附属第一人民医院泌尿外科 [2]上海交通大学泌尿外科研究所,上海20080

出　　处：《现代生物医学进展》2010年第13期2479-2481,共3页Progress in Modern Biomedicine

基　　金：上海市医学领军人才培养计划(LJ06050)

摘　　要：目的:分析微创经皮肾镜碎石术(minimal invasive percutaneous nephrolithotomy,mPCNL)治疗输尿管上段嵌顿性结石的临床疗效。方法:采用B超或X线定位,mPCNL治疗102例嵌顿性输尿管上段结石,其中2例经皮穿刺抽吸脓性尿液,留置造瘘管,抗炎治疗后二期手术。术后生命体征、B超和尿路平片(kindeyureterbladder,KUB)等检查并随访。结果:100例Ⅰ期穿刺成功并气压弹道或钬激光mPCNL,手术时间55-75min。碎石、取石时间15-35min。术后住院4-7d。无穿刺损伤腹腔脏器、术中未有肾盂穿孔和输尿管损伤、无大出血等术中和术后并发症。mPCNL术后2dKUB检查结石清除率为91.1%(93/102),9例残留结石,术后辅以体外冲击波碎石治疗。术后1个月结石清除率为100%(102/102)。结论:微创经皮肾穿刺取石治疗嵌顿性输尿管上段结石创伤小、恢复快且有很高的清除率,值得临床推广应用。Objective：To investigate the effect of the minimal invasive percutaneous nephrolithotomy（mPCNL） in the treatment of impacted upper ureteral calculi.Methods：A total of 102 patients diagnosedas impacted upper ureteral calculi were received mPCNL under B-type ultrasound or X-ray guidance.2patients for pyuria were established the renal access keeping tube and anti-inflammatory treatment for secondary operation.Vital signs,ultrasonic inspection and kindey ureter bladder（KUB）were done postoperation and follow-up.Results：100 patients of mPCNL were successful by pneumatic power or holmium laser.Operating time was 55-75 min.Gravel time was 15-35 min.There was no abdominal organs damage,no pyelonephritis perforation,no ureter damage and without hemorrhage intraoperative and postoperative complications.The clearance rate of stone was 91.1 %（93/102）after mPCNL in 2 days by KUB,Whereas 100 %（102/102） in 1 month.9 patients were performed ESWL postoperation for residual stones.Conclusion：mPCNL is regarded as a minimally invasive,faster recovery and high clearance rate for impacted upper ureteral calculi,which is worthy of clinical application.

关 键 词：输尿管结石 输尿管镜 经皮肾镜穿刺碎石术 

分 类 号：R693.4[医药卫生—泌尿科学]