无管化微通道经皮肾镜取石术治疗152例嵌顿性输尿管上段结石效果分析  

Effect analysis of no pipe of microinvasive percutaneous nephrolithotomy with lithotomy in treat 152 case of incarcerated upper ureteral

作　　者：仇向东[1] 钟狂飚[1] 

机构地区：[1]中南大学湘雅三医院泌尿外科,湖南长沙410013

出　　处：《国际泌尿系统杂志》2015年第3期368-371,共4页International Journal of Urology and Nephrology

摘　　要：目的探讨无管化的微通道经皮-肾镜取石术（mPCNL）治疗嵌顿性输尿管上段结石的安全性、可行性及手术指征。方法回顾性分析2011年7月～2014年2月之间符合条件的152例输尿管上段结石患者，行一期无管化微通道经皮肾镜下钬激光碎石取石术。在B超引导下经皮肾穿刺并行通道扩张，建立F14～F18的通道，碎石取石术后常规留置Double-J管及导尿管，记录每例所需要的手术时间、术中出血及输血情况，观察肾盂有无撕裂、有无临近器官损伤，计算结石清除率，记录术后导尿管留置时间及住院时间。结果152例患者均成功实施一期碎石取石术，术后未留置。肾造瘘管，F14通道21例，F16通道75例，F18号通道56例，平均手术时间（544-11）min，手中无活动性出血，无输血，无肾盂撕裂，无邻近脏器损伤。结石清除率97．3％（148／152），4例结石残留[均于术后3～5d复查KUB及B超提示残余结石直径分别为（4．0、3．6、3．5、3．2mm）]。无明显尿外渗、大出血等严重并发症．术后平均留置导尿管3．8±0．7d．术后平均住院5．04-0．8d。结论针对性选择符合条件的嵌顿性输尿管结石患者，无管化的微通道经皮肾镜取石术效果满意，安全，术后恢复快，痛苦小，平均住院时间少。Objectives To study the security, feasibility and surgery indications of no pipe of microinvasive percutaneous nephrolithotomy with lithotomy （mPNCL）in treat incarcerated calculi of upper ureteral. Methods 152 patients of upper ureteral calculi were chosened to proceed no pipe of microinvasive percutaneous nephroscope holmium laser lithotripsy from July 2011 to February 2014. Under ultrasound guidance, 152 patients were proceed with Percutaneous renal biopsy and expanded ureter, Established F14 -TI 8 channel. After opertation,indwelled Double J tube and catheter. Results 152 patients successfully proceeded no pipe of microinvasive percutaneous nephro- scope holmium laser lithotripsy, all patients dosent indwell renal fistula after operation. 21 cases of F14,75 cases of F16,56 cases of F56 ,The average operation time（54 _＋ 11 ）min. No bleeding, blood transfusion, renal pelvis lacera- tion and adjacent viscera damage during operation. The calculi clearance was 97.3% （ 148/152 ）, and 4 patients with calculi residual（ we finded calculi residual by KUB and B ultrasound after 3 -5days, the diameter of thecalculi was （4.0,3.6,3.5,3.2mm））. Indwell catheter（3.8 ± 0.7 ） days and in hospital for （5.0 ± 0.7 ） days. They were no se- vere complications as obvious bleeding, urinary extravasation ect. Conclusions The effect of no pipe of microin- vasive percutaneous nephrolithotomy with lithotomy（mPNCL） was satisfying,feasibility, fast postoperative recovery, less pain, less average length of hospital stay.

关 键 词：输尿管结石 肾造口术 经皮 

分 类 号：R693.4[医药卫生—泌尿科学]