单通道经皮肾镜取石术术后结石残留因素分析及对策  

Analysis and management of residual stones after single - channel percutaneous nephrolithotomy

作　　者：段支前 严春晖[2] 

机构地区：[1]湖北省英山县人民医院泌尿外科,438700 [2]解放军161医院泌尿外科

出　　处：《临床外科杂志》2012年第1期53-55,共3页Journal of Clinical Surgery

摘　　要：目的探讨影响单通道经皮肾镜碎石取石（PCNL）术后结石残留的因素。方法对单通道PCNL术治疗84侧患肾的疗效进行分析，观察肾脏穿刺点选择，肾盂肾盏结构以及结石类型对手术成功率及结石清除率的影响。结果①84侧患肾中有83侧成功实施PCNL术，手术成功率98．8％。②在成功实施手术的患者中，单通道PCNL结石总清除率达到84．34％（70／83）。③Ⅱ期手术后肾大盏〉3组的结石总清除率为73．5％（25／34），肾大盏≤3组的结石清除率为87．8％（43／49），差异无统计学意义。④Ⅱ期手术后多发性肾结石的总清除率为86．2％（44151），鹿角形结石为54．6％（6／11），单纯。肾盂结石为100％（17／17），单纯肾盏结石为3／4，差异有统计学意义。结论。肾穿刺点选择及结石类型是影响单通道PCNL术成功率和结石清除率的重要因素，在考虑不同肾盏类型对结石清除率影响时必须同时结合结石的分布才有现实意义。术前通过仔细研究KUB、IVU等其他辅助检查，综合考虑肾盂。肾盏结构以及结石类型因素，选择肾脏适宜的穿刺点是提高单通道PCNL术碎石取石效率的关键。Objective To study the factors of residual stones after single - channel percutaneous nephrolithotomy（PCNL）. Methods The curative effects of single - channel PCNL treatment for 84 cases of nephrolithiasis were observed, and the effects of kidney puncture site, renal structures as well as stone types on the success rate of surgery and the stone - free rate were analyzed. Results （1）The success rate of PCNL was 98.8% （ 83/84 ）. （2）The total stone - free rate was 84.34% （ 70/83 ） after PCNL operations. （3）After the second operation, the stone - free rate was 73.5 % （25/34）when number of major calyces 〉 3, and was 87.8% （43/49）when ≤3. The two rates had no significant difference. （4）Stone -free rates were different based on the variation of calculus types. As for multiple kidney stones, the total stone - free rate was 86.2% （44/51 ） after the second operation ,54.6% （ 6/11 ） in staghorn stone, 100% （ 17/17 ） in simple pelvic stone, and 75.0% （3/4）in simple calyceal stone. The rates had significant differences. Conclusion The selection of kidney puncture site and the calculus type are important factors to influence the success rate of single - channel PCNL and the stone - free rate. Structure of renal pelvis and calyces should be considered together with distribution of stones. Through careful study of KUB, IVU and other auxiliary in- spections, consideration of renal structures and stone types, as well as a suitable kidney puncture site are the keys to improve the efficiency of single - channel PCNL.

关 键 词：单通道 经皮肾取石术 上尿路结石 

分 类 号：R692.4[医药卫生—泌尿科学]