无管化经皮肾镜碎石取石术治疗上尿路结石的临床研究  

Tubeless Percutaneous Nephrolithotomy in Treatment of Upper Urinary Calculi

作　　者：王滕滕[1] 陈少安 尉春晓[1] 任祥斌[1] 陈修德[1] WANG Teng-teng;CHEN Shao-an;WEI Chun-xiao;REN Xiang-bin;CHEN Xiu-de(Minimally Invasive Urology Cencer,Shandong Provincial Hospital Affiliated to Shandong University,Jinan,Shandong,250014,China)

机构地区：[1]山东大学附属山东省立医院泌尿微创中心,山东济南250014

出　　处：《泌尿外科杂志（电子版）》2018年第2期21-25,共5页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨无管化经皮肾镜碎石取石术(PCNL)治疗上尿路结石的可行性、安全性和临床疗效。方法回顾性分析2017年7月至2018年4月本院采用无管化经皮肾镜碎石取石术治疗的36例上尿路结石患者的临床资料。观察患者结石清除率、疼痛视觉评分(visual analogue scale,VAS)、肾周血肿及积液发生率、尿外渗发生率、发热、出血及输血情况、术后住院时间等数据和指标。结果 36例手术均一期取净结石,手术时间15~60分钟,平均(30. 6±8. 2)分钟;结石清除率100%; VAS评分为(3. 08±0. 36)分;术后血红蛋白平均下降(6. 02±3. 06) g/L,无输血病例,无选择性肾动脉栓塞病例;无明显肾周血肿及尿外渗发生;术后有2例患者出现明显发热(体温> 38. 5℃),经抗生素治疗后好转;术后平均住院时间(2. 8±0. 6)天。术后4周复查,未发生其他明显并发症。结论在严格掌握手术指征、熟练手术操作的基础上,无管化经皮肾镜碎石取石术治疗上尿路结石是安全有效的。Objective To evaluate the feasibility, safety and efficacy of tubeless percutaneous nephrolithotomy （PCNL） for the treatment of upper urinary calculi. Methods In this study, from July 2017 to April 2018, 36 patients treated with tubless PCNL in our department were retrospectively analyzed. The stone clearance rate, visual analogue scale （VAS） pain score, the incidence of perirenal hematoma and effusion, the incidence of extravasation of urine, the incidence of fever, bleeding and blood transfusion, postoperative hospital stay were ohserved. Results All these 36 patients were successfully treated with tubeless PCNL. No residual stone was found. The average operation time was （30.6 ± 8.2） minutes, the mean VAS on the first day postoperation was （3.08 ±0.36）, the preoperative and postoperative hemoglobin decrease was （6.02 ± 3.06） g/L, no blood transfusion, angiography and embolization needed. No perirenal hematoma and urine leakage were found. Two patients got fever postoperatively （T 〉 38.5℃ ）. The average postoperative hospital stay was （2.8±0.6） days.All the patients were followed up for 4 weeks, and no other complication occurred. Conclusions Tubeless PCNL can be feasible for upper urinary calculi in these selected patients.

关 键 词：无管化 经皮肾镜碎石取石术 上尿路结石 

分 类 号：R699[医药卫生—泌尿科学]