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目的探讨24F通道无管化经皮肾镜取石术(PCNL)治疗上尿路结石的可行性和适应症。方法回顾性分析我院2012年3月至2016年12月182例24F通道的无管化PCNL。单纯肾结石97例(53.3%),单纯输尿管上段结石32例(17.6%),肾结石合并输尿管上段结石53例(29.1%)。结果平均手术时间(35.5±18.2)min,术后第1d血红蛋白下降(10.3±5.4)g/L,术后平均住院时间(4.3±1.6)d。11例(6.0%)出现肾绞痛,14例(7.7%)使用止痛药,10例(5.5%)发热,4例(2.2%)出现肾周血肿,1例(0.5%)见残余结石,并发症给予对症处理后均好转。结论 24F通道无管化经皮肾镜取石术在上尿路结石治疗中是一种安全、有效、微创的手术,但需掌握适应症,同时术者必须具备丰富的经皮肾经验。
Objective To investigate the feasibility and indications of 24F channel percutaneous nephrolithotomy (PCNL) in the treatment of upper urinary tract calculi. Methods A retrospective analysis of our hospital from March 2012 to December 2016 182 cases of 24F channel of ductal PCNL. Simple kidney stones in 97 cases (53.3%), simple upper ureteral stones in 32 cases (17.6%), renal stones with ureteral calculi in 53 cases (29.1%). Results The mean operative time (35.5 ± 18.2) min, postoperative hemoglobin decreased (10.3 ± 5.4) g / L on day 1 and postoperative average hospital stay (4.3 ± 1.6) d. Renal colic occurred in 11 patients (6.0%), analgesics in 14 patients (7.7%), fever in 10 patients (5.5%), hematoma in 4 patients (2.2%) and residual stones in 1 patient Complications after symptomatic treatment were improved. Conclusion The 24F channel percutaneous nephrolithotomy is a safe, effective and minimally invasive surgery for upper urinary tract stones. However, it is necessary to know the indications. At the same time, the surgeon must have rich experience in percutaneous nephrolithotomy.