B超引导下微创经皮肾镜术治疗无明显积水的肾铸型结石  

B ultrasound-guided minimally invasive percutaneous nephrolithotomy for staghorn calculi without obvious hydronephrosis

作　　者：孙道冬[1] 孙丹宁[1] 王勤[1] 李靖[1] 颜加强[1] 康元上[1] 蒙明森[1] 舒勇[1] 

机构地区：[1]解放军第324医院泌尿外科,重庆400020

出　　处：《局解手术学杂志》2011年第3期260-262,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨B超引导微创肾穿刺造瘘、经皮肾取石术治疗无积水的铸型肾结石的疗效。方法回顾分析2009年1月至2010年9月采用微创经皮肾镜术（MPCNL）治疗27例无明显积水的铸型肾结石患者的临床资料。结果 27例均成功建立经皮肾镜微创通道,25例患者一期单通道碎石取石,2例因出血和体位不能耐受,留置肾造瘘管后改二期碎石取石。19例患者一期一次手术取净结石;3例患者经2次MPCNL手术;1例患者经过3次MPCNL手术均取净结石;2例患者残留结石配合ESWL治疗,术后1~2个月复查结石排出,总结石清除率为92.6%。2例患者残留结石（单发）位于肾下盏,结石直径小于5 mm。结论 B超引导MPCNL治疗无明显积水的肾铸型结石安全有效。Objective To evaluate the effectiveness of B ultrasound-guided minimally invasive nephrostomy and percutaneous nephrolithotomy（MPCNL） in the treatment of staghorn calcul without obvious hydronephrosis.Methods The clinical data of 27 cases of staghorn calculi without obvious hydronephrosis treated by minimally invasive percutaneous nephrolithotomy from January 2009 to September 2010 in our hospital were retrospectively analyzed.Results Operation tracts of MPCNL were successfully set for all 27 patients.Twenty-five patients were treated by stageⅠsingle channel lithrotripsy,but 2 patients underwent stage-Ⅱlithrotripsy after the retention of nephrostomy tube due to hemorrhage and uncomfortable position.Nineteen patients cleared the stones through stageⅠMPCNL once,3 patients underwent twice,1 patient underwent MPCNL for three times.Two patients with residual stones underwent extracorporeal shock wave lithotripsy（ESWL） and the retained stones were removed 1~2 months postoperatively,the total stone clearance rate was 92.6%.Two patients had residual stones（less than 5 mm） in lower kidney calices.Conclusion B ultrasound-guided MPCNL for staghorn calculi without obvious hydronephrosis is efficient and safe.

关 键 词：B超 肾结石 微创经皮肾镜术 

分 类 号：R692.4[医药卫生—泌尿科学] R445.1[医药卫生—外科学]