经皮肾肾镜碎石取石治疗狭长盏颈型肾盏结石(附22例报告)  

Percutaneous nephrolithotomy for treating calyceal stones with slender renal calyces(Report of 22 cases)

作　　者：郭辉权 袁坚[2] 刘冠炤[2] 

机构地区：[1]从化市太平镇医院泌尿外科,广东广州510990 [2]广州医学院第一附属医院微创外科中心,广东广州510950

出　　处：《岭南现代临床外科》2011年第6期449-450,457,共3页Lingnan Modern Clinics in Surgery

基　　金：广州市科技计划项目(201102A214017)

摘　　要：目的探讨微创经皮肾穿刺取石治疗狭窄盏颈型肾盏结石的临床疗效。方法回顾分析我院采用微创经皮肾穿刺取石治疗狭窄盏颈型肾盏结石22例患者的临床资料,总结狭窄盏颈型肾盏结石微创治疗的经验和对策。本组患者女性10例,男性12例;平均年龄35.6岁,包括肾上盏结石10例,肾中盏结石5例,肾下盏结石7例。其中左侧肾盏结石9例,右侧肾盏结石13例.采用B超或X线定位引导直接穿刺结石所在肾盏,应用弹道碎石,同时以扩张鞘扩张狭窄盏颈。结果所有手术均成功完成,其中20例患者行一期经皮肾镜取石,2例行二期微创经皮肾镜取石,术后复查例均无结石残留。手术时间45～120min,平均65min。术中出血60～120ml,平均85ml。无术后严重并发症发生,无中转开放手术病例,术后7～12d出院。结论微创经皮肾镜碎石创伤小,清除结石的同时可以应用扩张鞘扩张狭窄盏颈,为有症状的狭窄盏颈型肾盏结石患者提供一种微创治疗的选择。Objective To investigate the safety and feasibility of minimally invasive percutaneoua nephrolithotripsy （MPCNL） in the treatment of renal caliceal calculi with constrictive calyces.Methods A data of 22 patients（12 males and 10 females,average age 35.6 years old）with symptomatic renal caliceal calculi,underwent percutaneous nephrolithotripsy,.were retrospectively analyzed.Of 22 patients,.the upercalyx calculi were in 10 cases,middlecalyx calculi in 5 cases and below calyx calculi in 7..The stones were located in left kindey for 9 cases and were in right kidney for 13..The operations were carried by MPCNL under the B type ultrasound guidance or X-ray in all patients,and the constrictive calyces necks were dilated with dilator and placed with a 16F nephrostomy tube.Results All operations were succesfully completed,of which 20 underwent percutaneous nephrolithotomy in one stage.Only 2 Cases needed a second nephroscopy for the residual stone.The average operating time was 65 min（45-120 min）and the average blood loss was 85 ml （60-120 ml）.No severe complications occurred in all patients.None need to transfer to open surgery during the operation.The hospital stay after surgery was 7-12 days.Conclusions MPCNL is an effective and feasible treatment option with less invasion and high stone-free rate for symptomatic renal caliceal calculi with constrictive calyces in selective cages.

关 键 词：肾结石 经皮肾镜 肾盏颈狭窄 微创治疗 

分 类 号：R692.4[医药卫生—泌尿科学]