摘要
目的探讨F18～F20多通道微创经皮肾镜取石术治疗复杂性肾结石的安全性与有效性。方法 2004年1月～2011年5月对67例复杂性肾结石行多通道微创经皮肾镜治疗。先取截石位,向患侧肾盂逆行留置F5输尿管导管后改为俯卧位,上腹部垫薄枕。C形臂X线定位后,在腋后线到肩胛下线之间取第10肋间以下最接近肾盏并能沿肾盏指向肾盂方向的穿刺点,18 G肾穿刺针穿入后组肾盏内逐级扩张后留置peel-away鞘建立通道,置入微创肾镜,直视下气压弹道碎石,利用灌注水流及输尿管导管注水将碎石冲出,稍大的结石可钳夹取出。术中X线透视了解结石残留情况,按上述方法进行多通道穿刺目标肾盏进行碎石,尽可能一期取净结石。结果 65例建立2个通道,2例建立3个通道。手术时间50～120 min,平均93 min;术中出血量15～200 ml,平均30 ml。一期取净结石55例,二期取净结石7例,结石清除率92.5%(62/67)。术后住院时间3～10 d,平均7 d。术后发生感染8例(11.9%),经头孢类抗感染药物及药敏培养选择抗感染药物治疗后,感染控制良好,7例治愈出院,1例尿培养证实为热带假丝酵母菌,拔除内支架后口服氟康唑(400 mg,qd)2周治愈。术后6 h活动性动脉出血1例,在DSA下行超选择肾动脉栓塞术后顺利止血。急性肾功能衰竭1例,通过3次血液透析,渡过少尿期后康复出院。结石残留5例,通过放置支架管后行体外碎石治疗,3例结石排出,2例无效。45例随访1～7年,平均5年,42例无结石残留,3例结石复发,其中1例2年复发,2例3年复发。结论多通道微创经皮肾镜治疗复杂性肾结石结石清除率较高,并发症低,经济方便,可作为较大复杂性肾结石治疗的首选方法。
Objective To assess the safety and efficacy of multiple-channel（F_18-F_20） minimally invasive percutaneous nephrolithotomy（MPCNL） in the treatment of complex renal calculi. Methods The clinical data of 67 patients with complicated renal calculi,who received MPCNL in our hospital from January 2004 to May 2011,were enrolled into this study.With the patients in lithotomy position,we indwelt a F_5 ureteral catheter retrogradely,and then in a prone position with a thin pillow under the abdomen.With C-arm X-ray positioning,we made puncture at the tenth costal space between the posterior axillary line and infrascapular line,at a point that is closest to the renal calyx and pointing to the renal pelvis.With an 18 G renal puncture needle,we placed a peel-way sheath to establish a channel for nephrolithotomy.X-ray monitoring was carried out during the operation so that to remove as many as possible stones. Results Among the 67 patients,two channels were established in 65 cases,and the other 2 had three channels.The mean operation time was 83 min and intraoperative blood loss was 30 ml（range,50-120 min and 15-200 ml）.The stones were completed removed in one session in 55 cases,and in two sessions in 7 cases.The total stone clearance rate was 92.5%（62/67）.The patients were discharged from hospital in 3-10 days postoperation（mean,7 days）.Eight patients（11.9%） developed infection after the procedure,and was then cured by anti-inflammation with sensitive antibiotics;seven of them was discharged from hospital afterwards;the other was diagnosed with Candida tropicalis,who was then cured by large-dosage fluconazole（400 mg,qd） for 2 weeks after the stent was removed.Active arterial hemorrhage was discovered in 6 hours after the surgery in one patient,and was cured by super selective renal artery embolization employed under DSA.Acute renal failure occurred in one patient,who was then cured by hemodialysis for three times.Residual stones were detected in 5 patients,who then received stent placement followed by EWSL,which cured three of them.Follow-up for 1-7 years（mean,5 years） was achieved in 45 cases,and 42 of them showed no residual stones,while the other 3 had recurrence in 2（1 case） or 3 years（2 cases）. Conclusions MPCNL is effective and economic for complex renal calculi with high clearance rate and low rate of complications.It can be the first choice for complex renal calculi.
出处
《中国微创外科杂志》
CSCD
2012年第3期236-238,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
多通道
微创经皮肾镜
复杂性肾结石
Multi-channel Minimally invasive percutaneous nephrolithotomy Complicated renal calculi
