标准通道经皮肾镜碎石术治疗肾和输尿管上段结石  

Percutaneous Nephrolithotomy through a Standard Channel for Renal and Upper Ureteral Calculi

作　　者：沈伟华[1] 徐庆康[1] 于永涛[1] 徐哲丰[1] 陈峰[1] 段跃[1] 于田强[1] 

机构地区：[1]武警浙江省总队医院泌尿外科,嘉兴314000

出　　处：《中国微创外科杂志》2012年第5期414-416,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨标准通道经皮肾镜碎石术治疗肾及输尿管上段结石的疗效及安全性。方法 2006年8月～2011年11月对758例肾和输尿管上段结石行经皮肾镜手术,采用瑞士第3代EMS超声气压弹道碎石清石系统,超声引导建立经皮肾通道,对质地一般的结石,直接使用超声碎石杆粉碎后清除,结石较坚硬者,先用气压弹道粉碎,再用超声碎石系统清除结石。放置F7双J管,留置F16肾造瘘管。结果单通道碎石743例,双通道12例,三通道3例。单次取石715例,二次取石43例。双侧结石同时手术12例。结石清除率为88.1%(668/758)。术后发生尿路感染72例(9.5%),出血26例(3.4%),其中行肾动脉超选择性栓塞17例(2.2%),开放手术止血1例,肾切除术1例。双J管未进入膀胱内5例,内镜下调整。702例随访3～45个月,平均14个月,结石复发8例,均为感染性结石,5例再次经皮肾镜手术治疗,放弃治疗3例。结论标准通道经皮肾镜碎石术治疗肾和输尿管上段结石安全有效,具有结石清除率高,并发症少的特点。Objective To explore the efficacy and safety of standard channel-guided percutaneous nepbrolithotomy renal and upper ureteral calculi. Methods From August 2006 to November 2011, in our hospital, 758 patients with renal and upper ureteral calculi underwent percutaneous nephrolithotomy. With the third generation of EMS （Switzerland） , we established a percutaneous channel under ultrasonic guidance to clean the stones. Double-J（F7 ） and nephrostomy tubes （F16） were placed after the procedure. Results Among the patients, a single channel was used in 743 of them, double channels were used in 12, and three channels were in the other 3 cases; 715 patients received a single session of the procedure, and the other 43 patients underwent two sessions to remove their stones. Bilateral surgery was carried out in 12 patients, who had stones at the both sides. The stone-free rate was 88. 1% （668/758）. After the operation, 72 patients developed urinary tract infection （9.5%） , 26 showed hemorrhage （3.4% , 17 of them received ultra-selective arterial embolization, 1 patient underwent open surgery to control the bleeding, and 1 patient received nephrectomy）. In 5 patients, double-J tube was not placed into the bladder, and thus a endoscopic adjustment was employed. A follow-up for 3 to 45 months was achieved in 702 patients （ mean, 14 months）, during which 8 patients had recurrent infective calculi, 5 of them received a second percutaneous nephrolitbotomy, and the other 3 gave up treatment. Conclusion Percutaneous nephrolithotomy through a standard channel for renal and upper ureteral calculi is safe and effective, with high stone-free rate and less complications.

关 键 词：肾结石 输尿管上段结石 经皮肾镜碎石术 超声 气压弹导碎石术 

分 类 号：R699[医药卫生—泌尿科学]