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目的:探讨微创经皮肾镜取石术治疗上尿路结石后二期取石的因素。方法:患者78例,平均53岁。输尿管上段结石9例,结石大小(3.0±1.0)cm;肾结石69例,结石大小(4.5±1.5)cm,其中非鹿角形结石49例,结石大小(3.1±1.1)cm,鹿角形结石20例,结石大小(8.0±1.8)cm。均采用微创经皮肾穿刺,输尿管镜下气压弹道碎石治疗,对结石清除率、并发症及二次取石术原因等进行统计分析。结果:78例患者中,一期取石68例(87.2%),二期取石10例(1 2.8%)。总结石取净率为82.0%(64/78)。平均手术时间86 min。一期取净结石者住院时间8～12天,平均10天。术后发热4例(5.1%);输血3例(3.8%)。结论:微创经皮肾镜取石术损伤小,住院时间较开放手术时间短,术中出血及并发症少,结石清除率高,部分需二期取石是其缺点,也是其优点,可重复取石。
Objective: To investigate the factors of second stage stone removal after percutaneous nephrolithotomy lithotripsy. Methods: 78 patients, mean 53 years old. There were 9 cases of upper ureteral calculi with stone size of 3.0 ± 1.0 cm, 69 cases of kidney stones and 4.5 ± 1.5 cm of stones, of which 49 cases were non-staghorn stones, 3.1 ± 1.1 cm in stone size and 20 For example, the stone size (8.0 ± 1.8) cm. All the patients were treated with minimally invasive percutaneous nephrolithotomy and ureteroscopic pneumatic lithotripsy, and the causes of stone clearance, complications and secondary stone removal were statistically analyzed. Results: Among the 78 patients, 68 cases (87.2%) were performed in stage I and 10 cases (11.8%) in stage II. The stone extraction rate was 82.0% (64/78). The average operation time was 86 min. A net stones were hospitalized for 8 to 12 days, an average of 10 days. Postoperative fever in 4 cases (5.1%); 3 cases of blood transfusion (3.8%). Conclusions: Minimally invasive percutaneous nephrolithotomy has the advantages of less injury, shorter hospitalization time, less intraoperative bleeding and complications, higher rate of stone clearance, and the second stage of stone removal, which is also its advantage and repeatable stone removal .