经皮肾镜术治疗开放手术后肾结石56例报道  

Percutaneous nephrolithotomy in patients with previous open surgery of kidney and upper ureter(A report of 56 cases)

作　　者：鄢世兵[1] 何昌孝[1] 袁正勇[1] 黄颖川[1] 王翰辉[1] 李冬[1] 

机构地区：[1]都江堰市医疗中心泌尿外科,四川都江堰611830

出　　处：《四川医学》2012年第12期2129-2131,共3页Sichuan Medical Journal

摘　　要：目的探讨经皮肾镜术治疗开放手术后肾结石的安全性和临床疗效。方法本组共56例患者,既往均曾行上尿路开放手术,包括肾盂和/或肾实质切开取石38例,肾盂离断成形术6例,输尿管上段切开取石术12例。左侧24例、右侧32例。结石单发12例、多发27例、鹿角状结石及多发结石17例。结石大小0.8cm×0.6cm～8.7cm×5.5cm。所有患者均采用B超引导下穿刺,逐级扩张建立经皮肾通道,结石负荷小的患者采用F20通道,结石负荷大的患者采用F24标准通道,气压弹道及超声负压粉碎并清除结石。结果 56例均顺利建立经皮肾造瘘通道,并行一期碎石术,51例单通道,5例双通道;穿刺通道在十一肋间37例,十二肋下19例;碎石手术时间15～180min,平均54min;术中出血量20～1000ml,平均150ml,2例输血;9例残石平均0.6～1.2cm,结石清除率84%(47/56)。术中无气胸或邻近脏器损伤等严重并发症,2例术后明显出血,经高选择性动脉栓塞后止血。8例肾功不全者,3例肾功恢复正常,5例维持在低氮质血症水平。结论经皮肾镜术治疗上尿路开放手术后肾结石安全有效。Objective To evaluate the safety and efficacy of pereutaneous nephrolithotomyfor renal calculi in patients with previous open surgery of kidney and upper ureter. Methods 56 patients with previous open surgery of kidney and upper ureter were retrospectively investigated by percutaneous nephrolithotomy. Of all 56 cases,38 patients had open pyelolithotomy and/or nephrolithotomy,6 had pyeloplasty, 12 had open ureterolithotomy. 24 calculi were in left kidney and 32 in right side. 2 cases had single calculus,27 had multiple, and 17 had staghorn calculi with multiple stones. The stone burdons were 0. 8em × 0.6cm ～ 8.7era ×5.5cm. All patients were underwent percutaneous nepbrolithotomy with B type ultrasound guidance and different access by pneumatic and ultrasonic power. Results The percutaneous renal accesses were successfully established in all 56 cases under ul- trasound guidance and immediate phase 1 lithotripsy were performed in all cases with single access for 51 cases and double accesses for 5case. The operation time were 15 ～ 180 rains with average time 54 rains. The blood loss were 20 ～ 1000 ml with averge 150ml, and blood transfusion for 2 cases. Total stone free rate was 84%. Residual stone fragments were found in 9 cases by postoperative KUB. No severe complications occurred except two patients received selective renal artery embolism for bleeding after PCNL. Of 8 cases with renal function insufficiency ,3 cases have got normal renal function, while other 5 cases suffered from lower azotemia. Conclusion It ＇ s safe and effective with little complications for patients with previous open surgery to treat renal calculi by percu- taneous nephrolithotomy with different access and pneumatic-ultrasonic power.

关 键 词：肾结石 开放手术后 经皮肾镜取石术 

分 类 号：R699[医药卫生—泌尿科学]